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COPYRIGHT DEPOSIT. 



SCHOOL SANITATION 



THE HYGIENE OF 
THE SCHOOLROOM 



BY 

WILLIAM F. BARRY, /\4. D., 

>\ 

MEMBER SCHOOL BOARD, CITY OF WOONSOCKET, R. I.; CONSULTING 

PHYSICIAN TO ST. JOSEPH'S HOSPITAL, PROVIDENCE, R. L; 

MEMBER OF AMERICAN MEDICAL ASSOCIATION 



Cbe providence press 

Snow & Farnham, Publishers 
providence, r. i. 






^ 










saaieSi 




COPYRIGHTED 1903 
BY 

SNOW & FARNHAM 

PROVIDENCE, R. I. 



'^ What will it profit a child to gain ^he whole 
world of knowledge and lose his own health ? " 



PREFACE 



The aim of the author in writing this book is to place 
in the hands of educators and others interested in child 
life trustworthy knowledge of the means of conserving 
the health of those entrusted to their care. Compulsory 
education, in this country, is almost universal, and ii 
should be the duty of the authorities to see that in the 
schools which children are required to attend nothing 
of an unhygienic nature exists. It is the truth, however, 
that until very recently little attention was given to the 
physical side of the child's nature, and that in the school- 
room the fundamental principles of hygiene were very 
little understood — at least were not practised. Some 
matters, to be sure, that concern the pupil's health, such 
as the need of proper diet, of proper clothing, and of 
eye-glasses, are beyond the province of the school author- 
ities, and can be reached only by advice to parents and 



X Preface. 

guardians. But many of the evils growing out of a 
common public school system are remediable: there can 
be, for example, better treatment of the problems of 
heating, ventilating and lighting. Upon these and kin- 
dred topics this book offers suggestions which the writer 
trusts will be of value to whoever is interested in improv- 
ing the physical condition of the children in our schools. 
A work of this nature is essentially for teachers, super- 
iritendents and school governing boards, and aims in all 
parts to be practical rather than to quote countless pages 
of statistics .usually as various as the individual opinions 
of the writers. The author hopes to combine the con- 
sensus of the best opinion with personal knowledge and 
investigation and make clearer the much discussed sub- 
ject of School Hygiene. 



CONTENTS 



CHAPTER I 

pac;k 

The Selection of a Site for a School Building . i 



CHAPTER II 
The Construction of School Buildings . 4 

CHAPTER III 

Ventilation . . . . . . . 15 

CHAPTER IV 
Heating . . . . . . . . .28 

CHAPTER V 
School Furniture ....... 33 

CHAPTER VI 
Light . . . . . . . . " . 45 

CHAPTER VII 
The Hygiene of the Eye ..... 50 

CHAPTER VIII 
The Hygiene of the Ear . . . . -67 



xii Contents. 

CHAPTER IX 

PAGK 

The Vocal Organs 7S 

CHAPTER X 
Relation of Contagious Diseases to the School . 8i 

CHAPTER XI 

Medical Inspection of Schools . . . .105 

CHAPTER XII. 
Modern Education and Health . . . .119 

CHAPTER XIII. 
School Diet ........ 135 

CHAPTER XIV 
Physical Training and Exercise . . . .141 



CHAPTER XV 
Corporal Punishment . 



146 



CHAPTER XVI 

Sickness and Accident in the Schoolroom . 153 

CHAPTER XVII. 
The Teacher's Health i5o 



DEFINITION 



Hygiene is the branch of medical science which con- 
cerns the preservation of health. 

School Hygiene is the application of a system of prin- 
ciples or rules designed to promote the health of the 
scholar. 



THE HYGIENE OF THE SCHOOLROOM 



THE HYGIENE OF THE SCHOOLROOM 



CHAPTER I 

The Selection of a Site for a School Building. 

The selection of the site for a school has an important 
bearing on the hygienic condition of the building. The 
primary consideration should be the drainage capacity of 
the soil; if possible, the land should be high and dry. 
Marshes or springy land must be avoided, else, although 
the greatest care in construction is taken, dampness in the 
cellar will most certainly result, and even if all the pre- 
cautions know^n to sanitary science are used in all other 
parts of the building, it will be impossible to overcome 
the evil effects of this dampness. There are many dis- 
eases which, while not due to dampness, are fostered and 
abetted by its presence, particularly diphtheria, typhoid 
fever, consumption and rheumatism ; besides, people liv- 
ing in and breathing a damp atmosphere are prone to 
suffer with headache and languor. 

An instance of unwise selection of a site is noted in a 
New England town where a schoolhouse was built on a 



2 The Hygiene of 

side hill that was notoriously springy. Twenty years 
have been spent unsuccessfully in trying to keep a dry 
cellar. Water forced itself in during the rainy season, 
filling the cellar bottom and leaving a grimy dampness on 
the side walls and a perceptible dampness in the rooms 
above. The result has been numerous complaints of 
rheumatism in the building and an unnecessarily high 
percentage of sickness. 

Made ground, that is, land that has been filled in with 
ashes, rubbish, and animal and vegetable refuse, is un- 
desirable school property. The air and moisture arising 
from such land are impregnated with foul and harmful 
gases, which are bound to make their way into the cellar ; 
and, for a number of years, at least until the refuse is 
entirely decomposed, such a neighborhood is iunhealthful. 
Where possible, a good gravel soil should be secured; 
if this cannot be had, then, in order of preference, a sand 
soil and sandy clay. Clay retains moisture very readily, 
and when a cellar is dug in such soil it is very likely to 
be a damp one. 

A school should be far from confusing noises, such as 
those made by railroad trains and certain factories. It 
is unpleasant to be located near industrial establishments 
that constantly give off noxious odors. Furthermore, the 
lot selected for a school building should be large enough 



the Schoolroom. 3 

to prevent neighboring structures from interfering with 
the necessary Hght. The building, as a general thing, 
should not cover more than half the lot. A good rule 
to follow is that no adjoining structure should be nearer 
than twice the height of the school building. 

In laying out a schoolyard, at least thirty square feet 
should be allowed for each pupil. For instance, if a six- 
room building is to be erected to accommodate three hun- 
dred pupils, the playground should contain not less than 
9,000 square feet. In the larger cities it will naturally be 
found difficult to have extensive grounds about the school 
building; but, wherever feasible, plenty of ground for 
play and exercise should be planned for. 

Too often, however, hygienic conditions are ignored in 
the selection of a school lot and more mercenary consid- 
erations are allowed to prevail. Cost becomes a great 
factor in the decision, and often a school is located in one 
particular place because the land is cheap. Or the cen- 
trality of a site may determine the selection, or the dislike 
of property-holders to have a school building too near 
residences, the school being looked upon as a very poor 
neighbor. But the importance of a wise selection of land 
for a school should rise above all other feelings, and the 
fact should be borne in mind that no lot is too good for 
school purposes. 



The Hygiene of 



CHAPTER II 
The Construction of School Buildings 

We shall consider the construction of school buildings 
entirely from a hygienic point of view. The general out- 
lines of the building, its imposing appearance, and its 
interior adornment, have received exhaustive attention 
from architects; and we shall leave the artistic aspect of 
the subject to those better qualified. Recently, it is true, 
following the trend of other professions toward special- 
ization, some architects have been giving careful study to 
school construction and have produced schools within the 
past ten years containing in the aggregate more sanitary 
improvements than had been worked out previously in 
as many decades. Experience, however, has shown, that 
many architects, have not, as yet, well handled the subject 
of school construction, and that too often such consid- 
erations as proper lighting and ventilation, proper loca- 
tion of cloakrooms and sanitary closets, are neglected. 

The construction of school buildings, indeed, should 
receive as much attention from the sanitary officer as 
from the architect ; and when the two shall work together, 



the Schoolroom. 5 

we can hope to see ideal school buildings. We should 
bear in mind that such buildings would be as varied as 
the demands of different communities. The building 
that would fill the needs of a metropolis would not be 
suitable for a country cross-roads and vice versa. There 
are general rules, however, that apply in all cases. 

The cellar should be so constructed as to be at all 
times dry; the top of the foundation should be at least 
three feet above the ground level, in order that plenty of 
light mjay be admitted to the basement. The floors 
should be of concrete or asphalt, and the walls of cement. 
It should not be a foul, dark storage room for old rub- 
bish, but a clean, ventilated, and well-lighted room that 
could be used in stormy weather with safety, as a play- 
ground for the children. 

It is not wise to construct high buildings for school 
purposes for two reasons : first, stair-climbing is not a 
healthful exercise, especially for growing girls; and, 
secondly, in case of fire the danger is greater than in a 
low building. Buildings of two stories high should be 
the rule, and the building should never be higher than 
three stories. The lowest grades should be assigned the 
rooms nearest the ground floor. 

The entrances should be large and sufficient in number. 
The corridors must be roomy, and, with the stairs, should 



6 The Hygiene of 

be fire-proof, even though the remaining rooms are not 
so. The stairs should be at least five feet wide, built 
with a landing near the middle of each flight. The steps 
should be of uniform box-like shape and of equal width : 
triangular steps and steps over eight inches high should 
be avoided. 

The cloakrooms or wardrobes should not be a part of 
the schoolroom. This latter point should receive par- 
ticular attention, as there can be no question that the 
outer garments of the children are a favorite hiding place 
for disease germs. Personal observation has shown that 
in houses where contagious diseases exist, the outer gar- 
ments receive little or no attention, and often form part 
of the covering of the sick one. When the patient re- 
covers, these same garments, so pregnant with dis- 
ease, are taken to the common cloakroom and huddled 
together with dozens of others, which thus become a 
most excellent medium for transmission of disease. 

A model cloakroom should be separated from the 
schoolroom and connected with the corridor. It should 
contain separate compartments, or lockers, for each 
pupil's garments, and windows should be so arranged 
that a constant supply of fresh air may circulate freely 
about the clothes and rid them of the disagreeable stifling 
smell that so often clings to them and fills the schoolroom. 




FIG. 1. 

Standard School Wardiobes in a School Hall. 



the Schoolroom. 7 

The cloakroom should not be kept warm, as germs thrive 
and multiply much more rapidly in a warm room than in 
a cold one. 

In several schools in England there are drying closets 
attached to the cloakrooms, for use on damp and rainy 
days for drying the wet shoes and outer wraps of the 
pupils. This most excellent arrangement could well be 
imitated in this country. Along this same line, it would 
be of great service, especially in times of epidemics, to 
have a small air-tight closet or room where garments, 
books, and all other articles brought from home to school, 
could be thoroughly fumigated. Successful fumigation 
can easily be done with formaldehyde vapor and with a 
comparatively inexpensive apparatus. 

The proper placing of water closets is an ex- 
ceedingly difficult matter, and even experts differ widely 
on this point. Some favor placing the closets in the base- 
ments or elsewhere within the building ; while others find 
positive objection to having the closet placed any nearer 
than fifty feet from the main building. Much can be said 
on both sides. If closets are placed in a cold, bleak part 
of the lot, many children will refuse to respond to the call 
of nature, and will suffer the ills attendant on such delay 
— constipation, hemorrhoids, etc. On the other hand, 
there is difficulty if the closets are in the building. For 



8 The Hygiene of 

example: a modern schoolhouse lately examined in a 
New England town was found to have been most care- 
fully planned— well lighted, well ventilated— and a model 
school building, save in one respect. On warm days in 
summer, and in winter when a strong fire was kept in 
the basement, an odor of urine permeated the whole 
building. The boys were undoubtedly careless, and the 
waste pipes failed to carry off the excreta quickly enough. 
The best plan is to have the closets connected with the 
basement and yet not in it, with their own ventilation and 
light. 

The important desiderata in a plumbing system in 
school buildings are the rapid and thorough removal of 
the waste, and the establishment, by means of proper fix- 
tures, of a complete barrier to the noxious odors and 
gases. Where the system is slow in carrying off the 
waste, decomposition of the sewage takes place and sewer 
gas forms. And, as school children are notably careless 
in the use of the closets, a system is to be preferred with 
the younger grades, from first to fourth, that performs 
-automatic flushing of the closets every five, ten or fifteen 
minutes during school hours, according as the mechanism 
i:? adjusted. For pupils from the fifth grade and upward, 
however, the chain and pull may be employed. There 
are many closets that embody all the desirable points, but 



the Schoolroom. 9 

the principal trouble seems to be in finding a satisfactory 
urinal for the boys. This should be constructed of slate 
and should be trough-like in shape, with a continuous 
and strong flow of water through it. The floor should 
be of slate for at least six feet from the urinal, and this 
part requires continual flushing and cleansing, as investi- 
gation shows that often the floor about, rather than the 
urinal itself, is the source of the odor. 

A system that commends itself to some and is in prac- 
tical use in American cities disposes of the excreta by 
burning. The waste prodii^cts are deposited on an iron re- 
ceptacle and at regtflar intervals a fire is built underneath 
in a grate, the flue of which is connected with the chimney. 
The heat rapidly consumes the products, which pass up 
the chimney in smoke and gases. This is not a system to 
be praised and should be thought of only where sewerage 
is impossible. In country towns, of necessity, the closet 
must be the old-fashioned earth closet in a remote part 
of the lot; and with a very little care in covering in fre- 
quently with dry earth or ashes, it serves its purpose ad- 
mirably. The teacher should never be reticent in speak- 
ing of the care of the closets, whether they are in the 
building or apart from it. Pupils should be taught that 
nuisances in such places will not be tolerated, not alone 
from a moral point of viev/, but a sanitary one as well. 



lo The Hygiene of 

If it is at all possible, there should be in each building 
a room for gymnastic purposes. A favorite place with 
many architects is the basement, and if this part of the 
building is properly constructed and is light and dry, it 
will not be an undesirable location. Here regular gym- 
nastic work and exercises under the supervision of the 
physical instructor can be carried out. A classroom with 
its desks and seats provides quarters too cramped for the 
physical instruction work. The best shape for an exer- 
cise room, as for any schoolroom, is an oblong, the longer 
side being that from which the light is admitted. 

Many states have carefuly drawn specifications that 
must be carried out in school construction to guard against 
fire and overcrowding. In Massachusetts "the law 
requires that a copy of the plans of every public building 
sihall be deposited with the inspector of factories and 
public buildings of the district in which such building is 
located before the erection of the building is begun, which 
plans shall also include the system or method of ventila- 
tion to be provided, together with such portion of the 
specifications as the inspector may require. The plans 
usually required are a plan of each floor, including the 
basement and the attic, if the attic is occupied, and a 
front and a side elevation, and also plans and sectional 
detail drawings of the system of ventilation. Further 



the Schoolroom. ii 

plans may be required by the inspector if deemed by him 
to be necessary. 

"In planning buildings to be used for schoolrooms, or 
places of assemblage above the first story, provision should 
be made for at least two stairways, and such stairways 
should be as far apart as practicable. No such stairway 
should be less than four feet wide in the clear, and wind- 
ing steps should be avoided. The height of rise and 
width of tread of all stairs, measured on the cut of the 
stringer, should be given on the plans. No flight of 
stairs shoud have more than fifteen steps between land- 
ings. The main stairways from places of assemblage 
should have a width of not less than twenty inches for 
every hundred persons accommodated therein. Such 
stairways should be railed on both sides. AH outside 
doors to such buildings should open outwardly." 

In O'rder to prevent fire, the Massachusetts building 
law makes further specifications as to the construction 
details of buildings, as follows : 

"All elevator wells and light shafts, unless built of 
brick, must be filled in flush between the wooden studs 
with fire-proof materials, or lined with metal, or plastered 
on metallic lathing, as may be directed by the inspector, 
and all woodwork inside of such wells or shafts be lined 
with tin plate, lock- jointed. Where floor beams rest on 



12 The Hygiene of 

partition caps or on girders, wall girts, or on wooden 
sills [the space] between such beams from the caps, 
girders, girts, or sills, to the lining floor above [must be 
filled in] solid with brick and mortar or other fire-proof 
material. When floor beams in frame buildings rest on 
ledger boards, ^ach floor [must be thoroughly fire- 
stopped] with brick and mortar resting on bridging pieces 
cut in between the studs, or, where practicable, on the 
ends of lining floor. In brick buildings the space be- 
tween the furrings on the outside walls or brick partition 
should be filled flush with mortar for a space of five 
inches in width above and below the floor beams of each 
story. Where basement or other flights of stairs are en- 
closed by partitions of brick or wood, the spaces between 
the studs or wall furrings must be so fire-stopped with 
brick or mortar as effectually to prevent any fire from 
passing up between such studs or furring, back of the 
stair-stringers. The soflits of all such enclosed stairs, 
and also partitions on stairway side, must be plastered on 
metal lathing. Where a building is occupied above the 
first floor for any purpose [insert statement of purposes 
referred to], and the lower story is occupied for stores, 
or other purposes not connected with the upper floors, 
the stairways leading to such upper floors must be en- 
closed with brick walls or with wooden partitions filled 



the Schoolroom. 13 

solid with brick laid in mortar or other fire-proof 
material, and plastered on both sides on metallic lathing, 
and all doors in such partitions lined with tin plate, lock- 
jointed. All long flights of stairs [must] have two 
smoke-tops in each flight, properly constructed. No pipes 
for conveying hot air or steam can under the law be 
placed nearer than one inch to any woodwork unless 
protected to the satisfaction of the inspector by suitable 
guards or casings of incombustible material. No wooden 
flue or air-duct of any description can be used for heat- 
ing or ventilating purposes. A space of at least one 
inch [must] be left between all woodwork and the chim- 
neys ; also around all hot air, steam and hot water pipes ; 
these spaces around chimneys and pipes, where they pass 
through floors, [must] be stopped with metal or other 
fire-proof material, smoke-tight. Steam and hot water 
pipes [must] have metal sleeves and coilars. All chan- 
nels and pockets for gas, water and soil-pipes [must] 
be made smoke-tight at each floor. The space around 
all metal or brick ventilating ducts must be fire-stopped 
at each floor with m.etal or other fire-proof material, as 
approved by the inspector. All chimneys [must] be plas- 
tered with one good coat of brown mortar, on the outside 
of brickwork, from cellar to roof. The ceiling of fur- 
nace or boiler and indirect radiator rooms must be plas- 



14 The Hygiene of 

tered on metal lathing. There should be not less than 
one foot in height of open air space between the tops of 
furnace or boiler casing and the ceiling. The entire 
cellar ceilings of schoolhouses and other buildings used 
for public purposes should be plastered on metallic lath- 
ing." 



the Schoolroom. 15 



CHAPTER III 
Ventilation 

In spite of the fact that the subject of ventilation has 
received exhaustive treatment from writers on school 
sanitation, that the dangers of ill-ventilated rooms have 
been repeatedly pointed out, and thait systems of ventila- 
tion have been elaborated and perfected, there are count- 
less schoolrooms occupied daily in which* the air is not 
so pure as in an ordinary stable. Many of these are in 
buildings constructed long ago, when no one thought of 
providing any other means of changing* the air in the 
schoolroom than the doors and windows offered. Such 
buildings are hard to ventilate without causing serious 
discomfort to those who are seated near the open door or 
window, and, in consequence, the schoolroom too often 
goes unaired. But not only in old-fashioned schools is 
the supply of fresh air inadequate or neglected : even to- 
day schoolhouses are being built with little or no regard 
to ventilation. 

There can be no excuse, however, for disregarding the 
dangers of having children live in an impure atmosphere : 



1 6 The Hygiene of 

sanitary literature teems with warnings. The New York 
Board of Health estimates that forty per cent, of all 
deaths are attributable directly or indirectly to bad air. 
Dr. A.'''N. Bell, of Brooklyn, N. Y., in a paper read be- 
fore, the Public Health Association of Philadelphia, says : 
'The depressed state of the organism 'Under the prevail- 
ing conditions of a badly ventilated schoolroom not only 
predisposes to epidemic diseases, but the Hability to and 
the danger of all diseases are intensified; and vicissi- 
tudes of weather, which under favorable circumstances 
may be encountered with impunity, under these depress- 
ing influences become dangerous perils; and doubtless 
much that is attributed to the season of the year supposed 
to be predisposing to scarlet fever, measles, Avhooping- 
cough, diphtheria, and some other common affections of 
children, is due to the same cause." 

Dr. James Johnson, in his "Diary of a Philosopher," 
says : ''All the deaths resulting from fevers are but as a 
drop in the ocean when compared with the number who 
perish from bad air." Nor can there be any doubt of the 
value of proper ventilation. Prof. S. H. Woodbridge, 
of the Massachusetts Institute of Technology, in his 
notes on ''Ventilating and Heating," makes clear the 
effects of the introduction of a system of efficient ventila- 
tion when he tells us that by this means " death rates 



the Schoolroom. 17 

have been reduced in children's hospitals from fifty to 
five per cent. ; in surgical wards of general hospitals, 
from forty-five to thirteen per cent. ; in army hospitals, 
from twenty-three to six per cent., and in prisons, from 
eighty to eight per cent." ; and Dr. Oliver Wendell 
Holmes, in his ''Medical Essays," is responsible for the 
statement that ''a simple measure of ventilation pro- 
posed by Dr. John Clark had saved more than sixteen 
thousand children's lives in a single hospital." 

Between good air and bad there is more difference 
than might be thought. Chemically fresh air consists of 

79 per cent, of nitrogen,"^ 

20.96 per cent of oxygen, 

.03 per cent, of carbon dioxide (carbonic acid gas), 
with traces of ammonia (nitric) acid and watery vapor. 

Expired air contains : 

79.2 per cent, of nitrogen (very little change), 

15.4 per cent, of oxygen (a loss of over five per cent. 

of this life-giving element). 
4.3 per cent, of carbon dioxide (an increase of over 

one hundred fold). 

Carbon dioxide in excess in the air is not poisonous, 
as was formerly believed, although when a great deal of 



* One per cent, of what was considered nitrogen is another elementary gas, argon. 



1 8 The Hygiene of 

this gas is present, as in the air at the bottoms of wells, 
the air is irrespirable. 

But air also contains volatile organic s,ubstances which 
the skin — by a so-called ''insensible sweating," not neces- 
sarily accompanying moist perspiration — and the lungs 
give off. These organic exhalations, which can be 
readily detected by the nose when one comes into a close 
room where a number of persons are sitting, are the 
deadly principle in vitiated air. To illustrate the poison- 
ous nature of the exhalations from the body, the follow- 
ing fact is cited: A four-year-old child, because of his 
good health and physique, was selected to represent the 
Infant John the Baptist in an allegorical posing. The 
child was stripped, and, to heighten the effect, his entire 
body was covered with gold bronze. The exhibition 
lasted several hours, but when the fete was over no effort 
was made to remove the coating and the following day 
the child died. The covering applied to the body sealed 
up these organic substances, which were absorbed into the 
system and caused the child's death. And that the sub- 
stances given off by the lungs are actively poisonous has 
been shown by Brown-Sequard. He found, upon taking 
the exhaled vapor, condensing it into liquid form, and 
injecting it into the artery of a rabbit, that death fol- 
lowed in less than a minute. Certainly these same toxic 



the Schoolroom. 19 

substances in circulation in the air to an abnormal degree 
must act deleteriously. 

Pupils soon show the evil effects of breathing impure 
air. Many tire quickly in school, although they are able 
to work with ease on the same tasks at home. The 
teacher notices that although good, bright work can be 
got from the child during the first period of the day, 
only a short time in the vitiated, .unhealthy atmosphere 
works an undesirable transformation. The child finds 
difficulty in application, is much less able to follow out 
a line of thought, and becomes dull, fretful and irritable. 
And there can be no question that many ^f the headaches 
attributed both by parents and by physicians to eye-strain 
and too close application to study, are the result of im- 
proper ventilation of our schoolrooms. 

The problem seems simple enough, for there is plenty of 
fresh air in the world. The difficulty is in bringing 
about a continuojus and regular exchange of pure for 
foul air in school buildings without causing drafts. 

But before considering the practical means of ventila- 
tion, we should consider the proper amount of air space 
required. A conservative and yet a safe allowance, sup- 
posing the schoolroom to be twelve feet high, would be 
twenty square feet of floor space for each pupil. Thus a 
room 25 feet x 30 feet, giving an area of 750 square feet, 



20 The Hygiene of 

would allow of 38 pupils. Each pupil would have a 
cubic air space of 237 feet, which is very near the gen- 
erally recognized standard. 

There are two methods of ventilation : the so-called 
natural method, by which the fresh air is admitted di- 
rectly to the schoolroom from outside by means of 
windows, doors and other openings; and the artificial, 
by which a definite amount of air is first warmed, and 
then, by means of special appliances, introduced into the 
room, being finally removed when no longer respirable. 
Two systems of artificial ventilation are in use : the grav- 
ity system, by which the currents of air are kept in 
motion by the difference in the weight of cold and hot 
air; and the fan system, by which the air is circulated 
by means of a forced draft from a rotary fan. As to the 
relative merits of the natural and artificial methods, there 
can be no question — the latter is always to be preferred. 
By either the gravity or the fan system it is easy to 
supply 2,000 cubic feet of air to each child per hour (or, 
as the Massachusetts standard requires, 30 cubic feet per 
pupil per minute) ; with only doors and windows it would 
be impossible to supply this amount without creating 
strong and uncomfortable drafts. 

In 188 1, Mr. Richard Briggs, a civil engineer of 
Bridgeport, Conn., made an elaborate series of experi- 



the Schoolroom. 21 

ments for the purpose of determining at what position in 
a schoolroom the inlets and outlets should be placed, in 
order to produce the most thorough change of air in a 
p-iven time. The result of these experiments was the es- 
tablishing of the principle that the warm air should enter 
the room from the inner walls, at a point six or eight 
feet from the floor, and that the foul air should be taken 
out from the bottom of the room on the same side. The 
results obtained from these experiments were published 
in the report of the Connecticut State Board of Health 
for 1881, and the system there recommended was em- 
ployed with great success in the Bridgeport High School, 
which was built the same year. 

The Code of Regulations of the Educational Depart- 
ment in England contains the following rules to be ob- 
served in planning Public Elementary Schools: "Apart 
from windows and doors there should be provisions for 
copious inlet of fresh, also for outlet of foul, air ; the best 
way of providing the latter is to build for each room a 
separate air chimney carried up in the same stack with 
the smoke flues. An outlet should have motive power 
as by heat or exhaust, otherwise it will frequently act as 
a cold inlet. The principal point in all ventilation is to 
prevent stagnant air. Particular expedients are only 
subsidiary to this main direction. Inlets are best placed 



22 The Hygiene of 

ill corners of rooms furthest from doors and fireplaces 
and should be arranged to discharge upwards into the 
rooms. Inlets should provide a minimum of two and 
one-half square inches per child, and outlets a minimum 
of two inches. All inlets and outlets should be in com- 
munication with the external air. Rooms should, in ad- 
dition, be flushed with fresh air about every two hours. 
A sunny aspect is especially valuable for children and 
important in its efifects on ventilation and health." 

The teacher who is fortunate enough to find herself in 
a building equipped with modern ventilating apparatus 
has little to think of on this score beyond familiarizing 
herself with the practical workings of the system; for 
the janitor may not always be at hand in an emergency, 
and the teacher then needs to know how to operate the 
apparatus herself. In some cases, for example, where 
fault was found with the performance of one or another 
system of warming and ventilating, the trouble was found 
to lie in the ignorance of the teacher, who had closed the 
wrong openings. But properly managed, a good system 
of artificial ventilation will very considerably lighten the 
all too heavy burden of the teacher's responsibilities. 

If artificial ventilation is not or cannot be installed, 
however, there are improvements that may be made upon 
the old-fashioned practice of opening wide the doors 



the Schoolroom. 23 

and windows. When windows have to be used without 
any fixtures for interrupting the direct flow of the outside 
air, much less discomfort to the pupil will result if they 
are opened from the top. But it is wrong to expect proper 
ventilation in a crowded room from doors and windows 
alone. Accessory means can be easily established, as, for 
instance, by making several openings around the room at 
the top for the exit, and others at the bottom for the en- 
trance of air. These openings should be provided with 
registers that can be opened and closed at will. If it is 
necessary to use the windows, it is desirable to employ 
some form of the numerous window ventilators in use. 
Some are merely plain strips of board fitted underneath 
the lower sash, allowing the air to enter upwards 
between the sashes. Others are wooden pieces per- 
forated in such a way as to direct the current of entering 
air upwards. Another is a device of glass after the fashion 
of a Venetian blind. An excellent adjunct appliance, 
efficient in its place, but hardly large enough to supply all 
the air required in a schoolroom, is a ventilator made of 
glass enclosed in a wood or metal frame, fitting any 
ordinary window and placed in adjustable brackets at an 
angle of from five to twenty degrees. It can be readily 
adjusted parallel with the window, and can be attached 
or removed without causing any defacement to window 



24 



The Hygiene of 



sash or frame. By its means, the fresh incoming air is 
deflected towards the centre of the ceiHng, where it meets 
the warmer air, with which it becomes thoroughly mixed. 
In this way a good, free circulation is produced without 
subjecting persons in the room to drafts. 




There are numerous tests for determining the relative 
amount of impurities in the air, but as all are very 
difficult to perform with the material at hand in an 
ordinary schoolroom, they are left for text-books on the 
subject of ventilation. "^ The teacher will seldom need to 
use anything but her olfactory nerves to determine that 



* In this country Mr. Gilbert B. Morrison has a very carefully prepared and valuable 
work on this subject. 



the Schoolroom. 25 

the ventilation is bad. The odor from the impurities of 
the air will often be increased by the odor of fetid dis- 
charges from the ear, of decaying teeth, and of sweaty 
feet ; and the teacher should have no hesitation in search- 
ing out the source of such annoyances and seeing that they 
are remedied as soon as possible. In all these cases, with 
the possible exception of prolonged discharges from the 
ear, cleanliness is all that is required. An unpleasant 
odor from a chronic ear trouble should be a sufficient 
cause for the excusing of a child from school. The air 
must be kept pure and sweet at all costs, and the teacher, 
in addition to seeing that the artificial ^^ntilation works 
as it ought, should seize every opportunity, as at recess 
and lunch hour, for thoroughly renewing the air by 
opening doors and windows. 

At this point it would be well to insist that the abolition 
of the old-time ten or fifteen minute recess was a serious 
error. It afforded an excellent opportunity to air all the 
rooms thoroughly and afforded a breathing spell for the 
scholars. And there was time to give the tired brain a 
rest, to ease the eye strain, and to relax the wearied and 
cramped muscles. But within the past few years the 
recess in many schools has been abolished as being old- 
fashioned and exceedingly difficult to carry out, because 
it interfered with school order. The abolition of the 



26 The Hygiene of 

recess, it is true, shortened the day's work of the teacher, 
but took from the pupil a very refreshing period. The 
school hours should be interrupted during both sessions 
for fifteen-minute recesses, or when there is but one ses- 
sion, there should be a recess of no less than thirty 
minutes. In Germany there is a legal requirement de- 
manding forty minutes intermission, exclusive of gym- 
nastics, for every five hours of school work. 

Governor Peck, of Wisconsin, once wrote an article on 
the abolition of the recess in his own characteristic man- 
ner. He says : 

"Sometimes it looks as though the school officials were 
overdoing the thing in trying to make the schools of the 
present day as different as possible from the old schools, 
where the fathers and the grandfathers got their educa- 
tion. The last 'improvement' that is suggested by school 
boards in some places is to do away with the recess in 
the middle of the forenoon and the middle of the after- 
noon, thus compelling the scholars to stay in the heated 
schoolroom from 9 o'clock in the morning until noon, 
and all the afternoon without a minute of rest. If the - 
abolition of the recess does not raise up a race of people 
with nervous headaches it will be a miracle. The old 
recess! Good gracious! it was the recess that kept the 
boys and the girls from dying in their tracks. 



the Schoolroom. 27 

"The recess in school is Hke the sherbet served in the 
middle of a banquet ; it aids the digestion like the blanched 
almonds and the celery and the olives. If the banqueter 
sat and ate of the solids all an evening, and never had the 
rest that comes with the et ceteras, he would die of 
apoplexy before the speaking began. If the schblar 
studies all the time until his head whirls his brain will 
become clogged. When you stop the recess you might 
as well seal up the brain and put it in a bottle of alcohol. 
The boy and the girl have got to have a time to cut the 
string that holds the cork down, and let the wolf howl." 



28 The Hygiene of 



CHAPTER IV 
Heating 

The temperature commonly accepted as proper for a 
schoolroom is 68°F, and should not be allowed to rise 
over 7o^.F. Two thermometers should be placed in the 
extreme corners, as the temperature at the forward part 
of the room, if heated by a stove, or at the registers or 
radiators, will often be above the required point, while 
that of the distant parts of the room is considerably below. 
The temperature should not vary more than three degrees 
in any part of the room. 

Residences, places of business, factories and school- 
rooms are ordinarily kept too warm, often at 8o^,F; and 
children who are accustomed at home to a temperature of 
8o^F will find discomfort in sitting in the schoolroom at 
68°F. But constant living in such an overheated atmos- 
phere renders one unable to stand any exposure without 
contracting colds and catarrhal affections. It has far 
more to do with the great increase in New England of 
such affections than has the much-blamed changeable 
climate. Indeed, many hygienists of repute, principally 



the Schoolroom. 29 

Europeans, advocate a much lower average heat in the 
schoolroom than that here suggested, some recommending 
a temperature of 61 ^F, and others are even as low as 
50.^F. In America, however, conditions are different, 
and it would not be wise to keep the minimum tempera- 
ture under 68°F. One cannot suffer from cold in a room 
at 68'*^F; yet temperature taken in over seventy school- 
rooms during the winter months averaged /S^F, ranging 
from 65^F to 85^F in several rooms. In some instances, 
when too great a degree of heat was found, the teachers 
confessed to liking a very warm room. However, per- 
sonal preferences should be dropped in th^ interest of the 
school as a whole; and this interest, we repeat, is best 
served by maintaining a temperature which does not vary 
more than two degrees from the normal point of 68°F. 

Every school should have its rules regulating the tem- 
peratures of the room in cold weather. If, at the opening 
of school work, the thermometer does not register 60PF, 
the school should be dismissed. If the thermometer is 
60PF or thereabouts, with a probable rising temperature, 
the pupils may be kept without danger. The first part of 
the day's work could be advisedly given to physical exer- 
cises. 

The methods of supplying heat are two, direct and in- 
direct. By the direct system the heat-supplying force is 



30 The Hygiene of 

contained in the room itself — a stove, an open fireplace, or 
the radiators of a steam or hot water plant. When a 
stove is used, great care devolves upon the teacher to see 
that no gases are given off and that a steady, constant 
heat is furnished, not too intense for those nearest the 
stove. For their protection, it is a good plan to use fire 
screens. In a small building, the open fireplace can be 
advantageously used, since it also serves as an excellent 
means of ventilation. The principal objection to the 
open fireplace is the great waste of heat in the chimney. 
The indirect system consists in warming fresh air out- 
side the room and introducing into the room the air so 
warmed. At present three methods are in general use 
— steam, hot water, and warm air furnaces. Each of 
these methods has many friends and is vigorously upheld 
as the best. One or another of the indirect systems 
should always be used when possible, as a more equable 
temperature can be kept and with far less distraction to 
pupil and teacher. In a steam plant, the fire heats the 
iron, the iron the water; steam is generated and is con- 
ducted from the boiler to the heating chamber, in which 
it heats iron again, and the iron then warms the air for 
distribution. The action of a hot water system is sim- 
ilar, except that steam is not generated, and that the water 
is conducted to the heating chamber at a lower tem- 



the Schoolroom. 31 

perature, necessitating a much greater radiating surface 
to warm the same amount of air. In the warm air fur- 
nace the fire heats the iron, the iron warms the air, which 
then passes directly to the point of distribution. 

The choice of a system of indirect heating will vary 
with the size of the building. A two, four or six room 
building can be heated very readily with a hot air appar- 
atus. A building with more rooms requires a steam or 
hot water heating plant or a combination of hot air and 
steam. 

An important point favoring the hot air furnace 
where available is the simplicity of its operation. The 
ordinary janitor for a school building is too often selected 
because of his inability to perform any other work in the 
community. Instead, one who has charge of a heating 
apparatus that might by neglect become a source of dan- 
ger, should be a carefully selected man, fully equipped 



Note. The manner in which the children are fed and clothed has a great deal to do 
with their power to withstand cold. Examinations made during the winter months 
showed that a number of pupils were very scantily clothed. Some had no undervests 
and the other garments were of the flimsiest nature. The teacher should, of right, 
investigate such matters as these, and if, as is often the case, the parents are unable to 
remedy the matter, it should be called to the attention of the superintendent to report 
to the poor commissions. Badly-worn shoes and wet feet should be looked after and 
no pupil should be seated at the daily work who has wet feet. Some means of drying 
the shoes and stockings should be devised, as there is nothing more harmful than sitting 
for hours with damp and wet feet. 



32 The Hygiene of 

for all the branches of his work, and invariably sober and 
industrious. 

The following requirements in regard to heating (and 
ventilating) apparatus are enforced by the state of Massa- 
chusetts : 

1. That the apparatus shall, with proper management, 
heat all the rooms, including the corridors, to 70^F in 
any weather. 

2. That, with the rooms at 70*^ and a difference of 
not less than 40^ between the temperature of the outside 
air and that of the air entering the room at the warm- 
air inlet, the apparatus shall supply at least thirty cubic 
feet of air per minute for each scholar accommodated in 
the rooms. 

3. That the supply of air shall so circulate in the 
rooms that no uncomfortable draft shall be felt, and that 
the difference in temperature between any two points on 
the breathing plane in the occupied portion of a room 
shall not exceed 3^.. 

4. That vitiated air in amount equal to the supply 
from the inlets shall be removed through the ventiducts. 

5. That the sanitary appliances shall be so ventilated 
that no odors therefrom shall be perceived in any por- 
tion of the building. 



the Schoolroom. 33 



CHAPTER V 

School Furniture 

The average child is employed at school work during 
the years from five to fifteen. This particular period is 
the growing, or formative, age of the child. Many of 
the bones by the fifth year are in a very imperfect state 
of development; a considerable portion of each bone is 
still composed of cartilage, which is very%easily moulded 
into or out of shape. In succeeding years the bone more 
and more displaces the cartilage, and not until about the 
age of puberty are the long bones and spinal column 
fully matured. Habit during this formative period will 
yield permanent after-effects of either good or evil, as the 

case may be. 

At this time in life children should be taught to stand 
correctly, to walk correctly, and to sit correctly. In 
standing, the shoulders should be thrown back, the chest 
extended, and the head held erect. The heels should be 
together, the toes extended, and the weight evenly dis- 
tributed upon both legs. In walking, the same correct 
posture should be maintained and an effort made to take 



34 The Hygiene of 

even, graceful steps with feet well lifted from the ground 
at each step. 

Both standing and walking can be helped at will; but 
in seating the children a more difficult problem is en- 
countered. Certainly every one must regard the old- 
fashioned bench, or box form, as a hopeless anachronism ; 
yet doubtless very many children to-day suffer from 
school furniture only less unsuitable than that of which 
Charles Lamb speaks in one of his essays. He says : 

"Oh ! how I remember our legs wedged into those un- 
comfortable sloping desks, where we sat elbowing each 
other, and the injunctions to attain a free hand, unat- 
tainable in that position." 

The seat and desk for each pupil should be most care- 
fully locked after ; for medical works are filled with 
words of warning about the use of ill-fitting school fur- 
niture. Many eminent physicians, especially in Europe, 
have given a great deal of study to the evils of ill-fit- 
ting school furniture, and have devised various desks 
and seats to remedy the defect. According to Dr. 
Farner's theory, a scholar while sitting at a desk im- 
properly constructed involuntarily assumes an injurious 
position. Often the injury is caused during writing and 
reading exercises, by the pupil's turning his head to the 
front or left while writing and downwards while read- 




L,'¥-«!^Wn'«-»^S»*s5i^!!^i!^'^»0^^= ■ 




Fig. 



Illustrates a desk too high for the child, causing elevation of the right 
shoulder in writing and a corresponding curve in the spinal column. 



the Schoolroom. 35 

ing. The bad results that may follow from putting chil- 
dren into seats too high and large for some, too small 
and low for others, are near-sightedness,* round shoul- 
ders, curvature of the spine, difficulty of respiration, dis- 
tortion of the upper part of the body, pains and tingling 
sensations in the feet. 

The danger from bad positions lies in the fact that 
they remove the centre of gravity of the body or of the 
head from its natural point of support. It is essential 
that the centre of gravity of the body be supported by the 
seat just as it is supported by one's feet w'l^ile standing. 
This is impossible, however, if cramped or stooping posi- 
tions are taken, as that throws the centre of gravity for- 
wards, to the right or left as the case may be. When a 
person sits erect, this centre of gravity is directly over 
the spinal column, and the head itself is supported and 
balanced by the muscles of the neck. But all this is 
changed by any forward movement, for then the centre 
of gravity of the head moves forward out of its natural 
position, and the head must therefore be supported and 
balanced by the help of a strong tension of the muscles of 
the back of the neck. When the muscles which support 



* The normal reading distance, measured from the pupil's eye to the book, should be 
fourteen inches ; children who show any considerable variation from the normal should 
be looked upon as near-sighted or far-sighted. 



36 The Hygiene of 

the head become tired, the head droops at once into an 
unnatural position and the shoulders become stooped. 

The more common faults of school furniture, as 
enumerated by Dr. D. F. Lincoln, of Boston, are : 

"First, the desk may be too high for the child's sitting 
height, causing an excessive elevation of the shoulder 
of the hand which the child will write with, usually the 
right. In attempting to get the elbow on the high desk, 
the shoulder is elevated, the corresponding one lowered, 
and the spinal column tilted. 

"Second, the desk may be too low, causing the child to 
stoop forward. This causes the neck to flex upon the 
body, producing interference of circulation from the 
head, congestion resulting, which interferes with the 
eyes. This same fault causes round shoulders from the 
continued stooping to be sufficiently near the work. 

"Third, desk too far from seat, with stoop of the body, 
injuring the eyes. Danger here is in injuring the health 



Note. Most authorities concede that better positions in the seat are maintained by 
the child in writing with the vertical method than with the old slant method. It is ad- 
visable that the desk lid should be movable as a shorter distance is needed in writing 
than in reading. 

Note. In speaking of school furniture we call the vertical space between the rear 
edge of the pupil's desk and the plane of the seat the " difference." It can be ascer 
tained by measuring the distance from the seat bones to the elbow when the arm hangs 
down. " Distance " is the special term for the horizontal space between the rear edge 
of the desk and front edge of the seat. 




Fig. 3 



Illustrates too great space between the seat and desk, causing" pupil to 
stoop too much, inducing round shoulders.^ 



the Schoolroom. 37 

by compression of the abdomen and .chest, dyspepsia, 
small chests and round shoulders. 

"Fourth, flat desk lid, interfering with freedom of 
writing, disadvantageous as respects receiving the light 
and compelling the child to hold up his book in order to 
see. 

''Fifth, seats too high, so that the feet are not supported 
and the legs grow weary. 

''Sixth, insufficient support for the back, causing fatigue 
and improper attitudes and consequent tendency for the 
spine to yield and take a side curve. 

"Seventh, seat not hollowed suitably, causing^pain and 
restlessness. 

"Eighth, a well-proportioned desk and seat, but not 
adapted to size of the child using it." 

In a proper seat the child should be able to sit back 
firmly and have both heel and sole touch the floor fairly, 
with the upper and lower leg forming a perfect right 
angle. Foot-rests are particularly tiresome, as they limit 
too narrowly the motion of the child's feet. The back- 
rest should follow in shape the normal curves of the 
spine and should not reach higher than the lower border 
of the shoulder blades, for otherwise the free movements 
of the arms and shoulders are interfered with. 

School furniture of the stationary kind requires the use 



38 The Hygiene of 

of different sizes of seats and desks to fit the needs of the 
pupils; furniture, on the other hand, so devised that the 
seat and desk can be adjusted to proper size by raising 
and lowering, is now in very general use, and no other 
kind should be thought of. Physicians, oculists, and edu- 
cators everywhere are united in advocating the use of 
adjustable school desks, and surely some importance 
should be attached to their advice, for their daily experi- 
ence brings additional proof of the serious damage re- 
sulting from fitting the child to the seat rather than hav- 
ing the seat fit the child. Dr. Charles L. Scudder, of 
Boston, an earnest student of school furniture, has made 
extensive examinations in the schoolroom, disclosing the 
following facts : 

"Examination made of thirty-seven schoolrooms in 
Boston showed that only one-third were provided with 
two sizes of desks and seats. In every instance where 
these two sizes were found, there were only a few of the 
second size, and the difference in these from the others 
was scarcely noticeable. It was found that the rule in 
grammar schools was that the seats were of the same size 
throughout the room and that these were placed at desks 
of uniform height. In the matter of age there were 
differences in schoolrooms of from five to nine years. 
Children with seven years difference in age and with 




FIG. 4. 

Illustrates a very common fault in school furniture, a too high seat. The 
child is unable to rest the limbs on the floor and leans over on the desk 
for support. 



the Schoolroom. 39 

fifty-seven centimeters difference in height were found 
seated at the same size desks in seats of equal height, but 
the results of such a condition are faulty and dangerous 
positions assumed in sitting and later in standing, and 
these positions unavoidably lead to serious deviations of 
the spine and to an unnatural elevation of the shoulders. 
These prodjuce, with growing children, serious deform- 
ities. They are caused by desks which are too high or 
too low for the pupil's lower leg, by seats too long or too 
short for the thigh, by distance from the desk to the seat 
either too short or too long. It was clearly brought out 
in this investigation that the method of seating in school- 
houses was defective in the extreme, leading to permanent 
deformity in the spine and distorted eyesight. In this 
respect, Boston is far behind other cities, such as Worces- 
ter, Springfield and Lowell. In these places it has been 
recognized that the only remedy for the evil lies in pro- 
viding adjustable desks, so that the pupil may be per- 
manently fitted with the desk he occupies, and nothing 
but adjustable desks are purchased. The director of 
physical training in the public schools at Woonsocket, 
R. I., in 1901, after examining about four thousand 
pupils, reported that over two hundred children could not 
touch their feet to the floor in any seat in their respective 
rooms, and that twenty-six children were too large for 



40 The Hygiene of 

the seats given them. In six rooms, over fifty per cent, 
could not touch the heels to the floor, the largest num- 
ber of misfits in any one room being thirty-two out of 
forty-six. Blocks were provided in many cases, but the 
fact remains that much of the school furniture is too large 
for the children who attend school in this city." 

Before the National Academy of Medicine, Dr. John 
Jay Moore read a paper on school furniture in which he 
said : "I will endeavor to explain what has been the cus- 
tom in seating Oiur schools, and then you can readily see 
where the difficulty exists. When we have had a new 
building to seat, the grade of the school and the num- 
ber of pupils to be accommodated in each room is ascer- 
tained by the superintendent, and the approximate ages 
of the children who will attend the school of a given 
grade. From this the size of the seats and desks to be 
used are obtained, regardless of the heights of the pupils 
in the different rooms. In the rooms in the modern 
buildings there are placed fifty-six seats expected to 
accommodate pupils from the age of eleven to fifteen, 
and in different rooms ranging in height from five feet 
eight inches to four feet four inches, with all the inter- 
mediate sizes. These fifty-six pupils, if the seats are all 
occupied, are expected to be perfectly seated with but 
two or three different sizes of seats. We find in one seat 




Fig. 5. 



Illustrates a too small " distance " between the seat and desk, causing 
pressure on chest and stomach. 



the Schoolroom. 41 

a pupil with the chin but Httle above the desk ; in another 
we find the desk so low that the pupil, when sitting in 
an upright position, can not see his work, thus being 
compelled to assume a position which will produce a 
crooked back or ruin his eye-sight. Still we find another 
little fellow who canot touch the floor with his feet, thus 
losing the support to the spine which becomes so neces- 
sary to the welfare of the child at this age. 

"For the lower extremities at nine years, those of the 
girls are longer, at eleven shorter, and from twelve to 
fourteen again longer. At fifteen the lower extremities 
of the girl almost cease growing, while those of the boy 
increase by four inches between the ages of fourteen and 
nineteen. The methods by which the seat-makers arrive 
at the sizes necessary leave all the scientific points out of 
their calculations, and give us an arbitrary size for all 
pupils of a given age and grade. The bad effects that 
result from the disproportion of the seat to the child are 
bad positions assumed in sitting, and a child that is com- 
pelled or allowed to assume faulty positions while sitting 
will assume faulty attitudes in standing. The effect of as- 
suming malpositions repeatedly tends to make permanent 
an,d to exaggerate these malpositions, which amount in 
time to permanent deformity. 

'Tn school children we have to deal with developing 



42 The Hygiene of 

spines, which are soft and capable of being molded. It 
has been demonstrated that as long as the weight of the 
shoulders and head falls on the spine symmetrcally only 
a posterior bending will appear. The moment this sym- 
metrical impression is changed there is a tendency for the 
bones and ligaments to become molded and grow into 
deformed shapes. The fact of the pupils being improperly 
seated causes in many cases lateral curvature. The chil- 
dren in trying to get into comfortable positions throw the 
spine out of plumb, thus predisposing them to all forms 
of curvature. 

''Time will not permit me to go into all the details of 
the positions which produce the stooped and round 
shoulders, as well as those that affect the eyesight. The 
important question now is, 'How can this matter be rem- 
edied?' Beyond a question, the adjustable school desk 
is the only way out of the difficulty." 

But the mere installation of adjustable furniture in a 
schoolroom means nothing of itself; indeed, many cases 
of pupils pioorly fitted with seats and desks are found 
where rooms are thus furnished. Every pupil must have 
the desk and chair adjusted to him carefully and changed 
twice a year to allow of growth. In consequence, many 
teachers object to adjustable furniture for the trouble it 
causes, and also for the unsightliness of the varied heights 




Fig. 6, 

Illustrates a desk and chair too small for pupil's size, causing cramping 

of the lower limbs. 



the Schoolroom. 43 

of desks and seats in the same schoolroom. These should 
only be trivial objections and are far outweighed by the 
great advantages to the child's proper growth. At the 
present date school authorities are certainly blamable in 
using stationary furniture ; but far more to blame are the 
authorities who install adjustable furniture and then 
neglect its proper adjustment to the children. 

There are over one hundred and fifty different makes 
of school desks and seats, varying from the simple, un- 
adorned bench and box-like desk to some exceedingly com- 
plex and cumbersome foreign contrivances. A number of 
excellent makes of adjustable furniture combine simplicity 
and real merit. A measuring gauge with full instructions 
is usually supplied, and the measuring may be done by 
the teacher and the changing of the seats by the janitor, 
according to the data supplied to him. So rapidly do some 
pupils grow that every teacher should know of the impor- 
tance of properly fitting school furniture, and can easily 
see that each child is comfortably seated. Changes may 
be necessary with the same pupil during the school year. 
The following table, carefully compiled by Dr. Bowditch, 
of Boston, Mass., will give an idea of the pupil's' growth 
during school life, and will readily illustrate how a desk 
at the beginning of a school year might be correct and 
yet at the close of the same year be disproportionate. 



44 



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the Schoolroom. 45 



CHAPTER VI 
Light 

In planning the location of a school building great care 
should be taken to see that it will be well favored by 
sunlight. Sites in hollows and near tall adjoining 
structures should be avoided. In the first place, no ob- 
stacle to the entrance of light should exist outside the 
building ; and, secondly, a plentiful supply should not be 
hampered by too few or too small windows. A won- 
derful improvement in the lighting of school buildings 
has been made in the last quarter century. A number of 
schoolhouses, particularly the older ones, were found very 
deficient in light, due to the small, low windows. Fig. 
8 is a type showing how little attention the windows re- 
ceived in the construction of a school building twenty- 
five years ago; and Fig. 9 is a strong contrast, giving an 
idea of a modern school building plentifully supplied with 
windows. 

The best light will be had where the longer axis of the 
building runs east and west and the windows are on the 
north and south sides only ; but where a building contains 



46 The Hygiene of 

four or more rooms on each floor, it will be more difficult 
to arrange for a fair distribution of light. In such cases, the 
corners of the building should face towards the cardinal 
points of the compass, enabling the sunlight to enter every 
room every day of the year. Aside from its advantages as 
regards light, a building so placed as to get a good sun 
exposure will be more easily heated and more healthful. 
For the best and most equal distribution of light, the 
schoolroom should be long and narrow, requiring win- 
dows on but one side. The desks should be so placed that 
the light will not shine in the pupil's eyes, but come from 
the left and rear. The light from the left is best, because 
it falls without shadows upon the desk. As the great 
majority of the pupils are right-handed, they would be 
annoyed, when writing, by the shadows that the light, 
coming from the right, would cast upon their work. Cross 
lights from both right and left are also objectionable. 
Light from the front is sure to dazzle the children's eyes. 
If the light from the rear predominates, the pupil's head 
casts a shadow, and there is the added objection of the 
teacher's inconvenience in facing light from the rear. If 
the light from this source, however, be indispensable,, the 
teacher can change the location of the desk to the rear of 
the room, where the same oversight of the pupils could be 
had. Many teachers prefer their desks in this 




o 




CO 



pi 



o 
o 

'o 
o 






CI, 



03 

O 

C/2 



the Schoolroom. 47 

position. But for teacher and pupils alike, light from 
the side is desirable. 

The windows should be high, reaching almost to the 
ceiling, and should cover an area equal to at least one- 
fifth of the floor space of the room. For instance, to de- 
termine whether sufficient light can be admitted : first, 
find the floor space by multiplying the length by the 
breadth of the room ; then multiply the height of each 
window by the width, and this product by the number of 
windows. The latter amount should be at least one-fifth 
of the area of the floor. 

Robson, an English authority, contends •that the win- 
dow-sills should be at least five feet above the floor, and 
that the windows should run very high, in order that the 
light may descend on the pupil's work. This, however, 
in the case of an ordinary room of average height (twelve 
or thirteen feet) , would entail a sacrifice of at least a 
foot of good lighting space, as there is little danger of 
the light shining upwards into the pupils' eyes if the sill 
of the window is three and one-half or four feet from the 
floor. 

In every part of a well-lighted schoolroom the pupil 
should be able to see to read well without an extra effort, 
at the normal reading distance, which is about fourteen 
inches. Artificial illumination should never be considered 



48 The Hygiene of 

in a schoolroom, except in evening schools, where its use 
is imperative. In such cases, the best light, from a 
hygienic point of view, is the incandescent lamp with 
ground glass globe. The use of the photometer, which 
measures the exact amount of light in a given room, 
will show that there are many schools to-day whose light 
needs to be greatly improved. This may be done by en- 
larging the windows both in breadth and length, and also 
by using reflectors and prisms, to be placed where the 
light enters, which greatly increase the amount. 

The most evil effect of insufficient light is the defective 
eyesight now becoming so common in school children. 
It is not necessarily the continuity and closeness of appli- 
cation, but the bad conditions under which the eye must 
work that are responsible for so much eye-strain. Dr. 
W. A. Mov/ry cites a case which well proves this par- 
ticular point: 

"A school was built wherein special pains were taken 
with hygienic matters, good air and excellent light were 
abundant. The two hundred and fifty boys were exam- 
ined upon entering, again in two years, and lastly in two 
years more. Almost without exception the eyesight, in 
spite of the constant use, was improved, showing that it 
is possible to obtain the right amount of light and the 
good effects folowing. The conditions bringing about 




f 






1 ! f , i*,.. 




^ ^ "* B 




'^ V 



j,*ims 




FIG. 9. 

Showing modern school building plentifully supplied with windows. 





Fig. 9. 

Showing modern school building plentifully supplied with windows. 



the Schoolroom. 49 

such results were as follows : Light admitted from one 
side and that from the lelc side of the pupils as they were 
seated. Window space equalled ten per cent, of floor 
space. Windows long and high. Rooms were long and 
not wide, no pupil being seated farther than twenty-seven 
feet from the source of light. No swivelled blinds, ad- 
mitting light through the crevices, but a semi-opaque 
curtain." 

Some schoolrooms have a fair amount of light on dry, 
clear days, and but very little on cloudy days. A teacher 
in such a room is justified in seeing that too close appli- 
cation, as in reading, is not required on such days, but 
that exercises at the blackboard are substituted. 

Too much light, with its blinding glare, is as harmful 
as too little. When the sun shines directly on the pupils 
and their work, it should be toned down with a sliding 
curtain of a light straw color. The best curtain is the 
one that works on a sliding device, enabling it to be ad- 
justed to any part or space of the window. 

The walls of the schoolroom should be of a light green 
tint as the reflected light would then be most easy upon the 
eyes. 



50 The Hygiene of 



CHAPTER VII 
The Hygiene of the Eye 

That our power of vision is degenerating cannot be 
gainsaid : defective eyesight is one of the penalties we pay 
for education. vSavage nations have especially good sight 
and very little trouble with the eyes. Nations that follow 
agriculture, or whose work is not of a very fine grade, 
or where the education of the young is limited, have far 
better eyesight than highly educated people whose work 
is of a more refined order. Germany is the greatest 
sufferer : one investigator says that sixty-nine per cent, 
of its inhabitants have defective vision. Children in the 
country, where the range of vision is greater than in the 
crowded cities, are not so prone to eye-troubles as city 
children. But though this degeneracy is a condition that 
accompanies advance in civilization, we should not accept 
it as inevitably a result of civilization. We should rather 
let it spur us on to do all in our power to better the con- 
ditions that aflfect vision. In this country, owing to the 
enormous increase of defective eyesig^ht, the subject is 
forcing itself upon the medical profession and the laity 



the Schoolroom. 51 

as well. It is a well-known fact that this trouble is 
hereditary and also congenital. The scientific researches 
of Dr. Ely, of New York, prove concUisively that in a 
large number of cases children are born far-sighted. 
Formerly it had been held that the only congenital defect 
found in the new-born was near-sightedness; but Dr. 
Ely had the opportunity of examining the eyes of a 
number of infants and was surprised to find a large 
majority came into the world with far-sighted eyes. In 
most cases, the trouble would naturally, in time, grow 
less, if only the eyes were used with great care. Instead, 
we have early and constant application ^o books in poor 
surroundings, and a consequent increase of the difiiculty 
before the tenth year is reached. In Germany, Dr. Con- 
rad, investigating among school children, found that 11 
per cent, were short-sighted at nine years, 55 per cent, 
at eighteen, and 62 per cent, at twenty-one. Dr. Loring, 
an American investigator, found that school life rapidly 
impaired vision, but not to such a startling extent as in 
Germany. According to his figures, at nine years 3.5 per 
cent., at eighteen 20 per cent., and at twenty-one 2'j per 
cent, suffer from short-sightedness. 

The farther one progreses in the scale of education, 
the greater will be the liability to injury of the eyes. 
This point is well broug^ht out by Dr. Cohn's table : 



52 The Hygiene of 



Average per cent. Average amount 

°° ^" of short-sightedness. short-sightedness. 



Country 1.4 1/24 

Primary 6.7 1/23 

Intermediate 10.3 1/22 

Polytechnic 19.7 1/20 

Latin 26.2 1/19 

Universities 59 -o 1/12 

Knowing, then, that many children have weak eyes long 
before they enter the schools, we should make every effort 
to guard the eyesight of pupils and to study the conditions 
and means of its improvement. 

The strangest point brought out through an extensive 
examination by the writer of the eyes of school children, 
and adults as well, was that although the eyes of many 
were seriously affected, the persons were apparently 
ignorant of the fact. The onset was insidiaus, and little 
notice had been taken until the damage was irreparable. 
Twelve pupils were found who had practically no sight 
in either one eye or the other, yet were doing the required 
school work. The remaining good eye had been saddled 
with the work of both and was doing it as well as pos- 
sible. It so happened that the trouble with the eye was 
in the retina and the optic nerve; and as the child did not 



the Schoolroom. 53 

complain, and there was nothing in the outward appear- 
ance of the eye to draw attention to it, it passed un- 
noticed. A number of teachers frankly admitted that 
they had thought many pupils who in reality were suffer- 
ing most severely from defective vision, merely stupid 
and inattentive. 

The writer examined the eyes of one thousand school 
children in their respective schoolrooms. The Snellen 
test types were used, and each eye tested separately. The 
pupils were from eight to fifteen years of age, and were 
of all social grades. No difference wa^ noted between 
the aptitude of poorer, ill-nourished children having de- 
fective vision and that of the children of the well-to-do. 
Very slight defects were not noted, but all marked had 
noticeable trouble. 

The results, to say the least, were appalling. Of one 
thousand examined, 334, or 33.4 per cent., were defective. 
One in every three examined was doing work for which 
he was not fitted, was straining his eyes to do that which 
required normal eyes. No allowance was being made in 
his case, as, in the majority of instances, the teacher was 
unaware of the difficulty. The usual symptoms of eye- 
strain, such as headache, restless sleep, loss of appetite, 
twitching of the eye and lid muscles, are not always 
present, and nothing but periodical examinations of the 



54 The Hygiene of 

eye will show existing defects. Often, too, many piupils, 
from a natural reticence, will not complain, although 
suffering. 

The following table shows the result in detail: 

ONE THOUSAND CASES EXAMINED. 

Both eyes defective < . . 146 

Left eye only 124 

Right eye only 5^ 

Entire absence of sight in one eye 12 

Number of cases of strabismus, or squint 28 

Those defective using glasses to correct vision 16 

Not using glasses 318 

Granular lids 4 

Corneal scars ., 2 

It is little less than criminal that conditions are allowed 
to exist that work such wholesale havoc with the chil- 
dren's eyes. Our first great duty is a realization of the 
situation, a survey of the probable offending causes, and 
an earnest attempt at their betterment. 

If we could understand the beautiful and delicate 
mechanism of the human eye we might take greater pains 
to preserve its usefulness. Nature has wisely foreseen 
the delicacy of the eye, the great care required for its 
well-being, and the necessity of guarding it better than 



the Schoolroom. 



55 



the organ of any of the other special senses. It is set into 
and protected by the bony orbital cavity. In front it is 
protected by two curtains, the eyelids. 

The eyeball, on account of its almost incompressible 
nature, cannot be drawn into the socket, but simply 



Caiialu'SeUemnii 

^~~i^ jvctiiirj'arii 
-'rfdU 




C'nnaUi _., 



o^ncwa 



FIG. 10. 



56 The Hygiene of 

rotates there, being drawn to either side, up- 
wards or downwards, by small muscles attached to the 
contiguous bony structures. When the adjustment of 
the muscles is perfect, a person is able to draw the eye 
to one side, but the corresponding muscle having an equal 
power, the equilibrium of the eyeball is maintained. In 
consequence of children's diseases, sometimes one of 
the small muscles becomes paralyzed. This muscle is no 
longer able to do its allotted work of helping to hold the 
eye in position, and the eyeball is pulled to the opposite 
side by the unaffected muscle. This condition is known 
as strabismus, or squint, and often follows early cases of 
long- or short-sightedness. 

These cases, as soon as noticed by the teacher, should 
be brought to the parents' attention, with a request that 
an attempt be made to remedy the defect. Very good 
results are often secured by the wearing of carefully se- 
lected glasses upon an oculist's advice. Undoubtedly the 
parent will notice the squint as soon as the teacher, but 
the request of the latter to have something done will 
usually produce good results. Sometimes, however, it 
will be difficult to impress an ignorant person with need 
for action in such cases. One mother who was re- 
minded of her duty in a neglected case thought she would 
be "flying in the face of Providence." She was finally 



the Schoolroom. 57 

convinced, nevertheless, of her error in the matter, and 
the case was referred to an ocuHst, with great benefit. 
With some long-standing cases, glasses will not mend 
matters, and an operation will be necessary. This opera- 
tion is simple, however, and usually successful. And 
oculists are compelled to operate in fewer cases of this 
kind each year, as they are now becoming more adept at 
removing the difficulty without recourse to an operation. 

The danger when an eye turns in or out or away from 
its fellow is that the power of sight begins to fail in the 
eye and goes on increasing. Every case, then, of squint 
discovered should be referred to the eye specialist. 

In studying the eye as shown in Fig. 10 from before 
backwards, we see the cornea, the aqueous humor, the 
pupil, the iris, the crystalline lens, the vitreous humor, and 
the retina. The cornea, perfectly transparent, is the first 
structure through which the light passes. The aqueous 
humor fills the space between the back of the cornea and 
the lens. The iris divides this space into two chambers, 
the anterior and the posterior. The colorless, transparent, 
bi-convex, crystalline lens serves to focus the light enter- 
ing the eye. The vitreous humor is a soft, jelly-like sub- 
stance, clear and transparent. The retina is 'the innermost 
lining of the eyeball, and is the sensitive area upon which 
the images from external objects are refracted. 



58 The Hygiene of 

ir- A 




FIG. 11. 

SHOWS THE MUSCLES OF THE EYEBALL IN NORMAL POSITION. 

A, A. The parallel optic axes. C, C. The centres of motion of the 
globes. B, B. Axes of rotation of the oblique muscles. Z>, D. Axes 
of rotation of the superior and inferior muscles. n, n. External 
straight muscles, z, i. Internal straight muscles. <?, o. Superior 
oblique muscles, running through pulleys at D, D. s. Superior straight 
muscle of one eye. This muscle is removed in the other eye to show 
the optic nerve, m, m. Attachments of the inferior oblique muscles, 
which cannot be seen in this view from above. The space between 
Z>, Z>, is the cavity of the nose. 



If we look at a house a mile distant and then look at 
one of the fingers placed before the eyes, we find it can 
only be done with a distinct sense of muscular effort 
somewhere in the eye. This effort, spoken of as accommo- 
dation, is the same act as is accomplished by the screw in 



the Schoolroom. 



59 




FIG. 12. 




FIG 13. 




FIG. 14. 



6o The Hygiene of 

an opera-glass. It is performed by the aid of ciliary muscle 
and the suspensory ligament of the lens, which alter the 
convexity of the lens. Emmetropia is a term used to 
designate normal vision as illustrated by Fig. 12, when 
parallel rays entering the eye are focused exactly upon 
the retina. But in some eyes the eyeball is too long, and 
the parallel rays meet in front of the retina, as shown in 
Fig. 13. This condition is known as myopia, or short- 
sightedness. To enable such eyes to see distant objects 
it is necessary to use concave glasses. Or the eyeball 
may be too short; then the parallel rays come to a focus 
behind the retina, as in Fig. 14. This condition is called 
hypermetropia, or long-sightedness, and for its correction 
convex glasses are needed. In yet other cases, owing to 
the fact that the cornea or the crystalline lens is not true 
in shape, the rays are not focused at any single point upon 
the retina. This is spoken of as astigmatism, and is 
usually corrected by cylindrical glasses. 

These are the principal defects that are found in chil- 
dren's eyes, and though the teacher is not expected to 
be able to differentiate them, she should make it her duty 
to report all cases to the proper authorities. In cities or 
towns where a medical inspector is employed in the 
schools, a great burden of responsibility is lifted from the 
teachers' shoulders. If there should be no such officer, 




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60 





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the Schoolroom. 61 

the teacher can easily learn to discover at least the most 
flagrant cases of defective vision. 

The type as printed on the plate opposite can be used 
in examining the eyes. The record should be kept as fol- 
lows : R. V. is the abbreviated form of writing "right 
vision"; L. V. "left vision." Seat the pupil twenty feet 
from the test types, and, if examining the right eye, place 
a piece of cardboard before the left eye. If the five rows 
of type can be read entire, vision is normal, or 
R. V.=2o/2o. If, however, only the four upper rows are 
read, and the thirty-feet type are the smallest discernible, 
the vision would be 20/30. If only the upper row can 
be read, the vision would be but 20/60. Proceed in the 
same manner with the left eye, and use the same means of 
recording the degree of vision. For a reading test, the 
normal eye should be able to make out the following dia- 
mond type at a distance of twelve inches : 



Tsfi K&cuini ol memory, which receives and retains Mea* 
(ud iKidgefi, and which e.xliibtid ibmii again witfa or mtbout 
the exercise of voljiion, early becume the eiibjeox ol 
philofiophical r^sedTob There are very tamy curious 
pbenomeDa connected with tbis power of the ipind , it I3 
*omeiimee as recreant to ite trusty wben mofli ita aervlw 
amy be required, aa the veriest bankrupt j fti other ume% 
wbcQ in a fit of etrange caprice, It wilt obtrude upoo us 
iQ a moAt unwelcome and uaceremonioua oianner. heap. 
iQg upon ue tbougbta and tbiaga we would willingly bury 
tn oblivion \ti, after ail, memory a Indlapensmble to 
mor&I economy . ita aid 10 aa mu^h required In ibing9 
mean aa in things immense VVuhoui thia myatei'lou^ 
private secretary we could not enact ou» several pan* 00 
the arena of life , oui boaated being u^old h* reduced 
to a mere vegetable exlsteaoe Ucmory 19 aaid to b« 
eaaendaj to every kind of action timid animala U9 itv 
iDgdied to avoid capture, and 10 &et from the nitackt 
of ife very ferocioua. more from th« remembmnc« ol tlie 
coo»equeDce8 of prwiou* auff^rfn^ tbao from wh<i »• 



FIG. 15. 



62 The Hygiene of 

With children who are not yet familiar with the alpha- 
bet the above tests are useless. For such Dr. Cohn sug- 
gests the use of a line of capital E's, the child to deter- 
mine, at a distance of twenty feet, the direction in which 
the arms of the letter point, whether upwards, down- 
wards, right, or left. 

m E 3 III m 

Fig. 17. 

To examine for astigmatism is far more difficult than 
to examine for hypermetropia or myopia. For such an 
examination the horizontal and vertical lines of Fig. i8 
may be used. Test one eye at a time, at a distance of 
twenty feet. If astigmatism is present, some of the lines 
will be blurred and run together, while the others will be 
clear and well-defined. 

A peculiar anomaly in some persons — most commonly 
men — is a failure to distinguish colors. This defect, 
known as color-blindness, is theoretically explained as 
being caused by the absence of one or more of the color 
sensations. To detect it, a heap of worsted yarn of all 
tints is taken, and a thread of a particular color, for in- 
stance a red, is selected. The subject is then required to 



the Schoolroom. 



63 




FIG. 18. 

TEST FOR EXAMINING THE EYES FOR ASTIGMATISM. 

pick out from the heap all of the other threads of the same 
color ; if red-blind, he will choose not only the reds but the 
greens. It is often a matter of consequence to discover 
this peculiarity, especially in railroad men and sailors, 



64 The Hygiene of 

since the colors most often mistaken are red and green, 
the important colors in railroad and marine signals. 

Now, when each pupil's eyes have been examined either 
by the medical officer or by the teacher, the parent shouk! 
be notified of the condition of the child's eyes and strongly 
encouraged to have the proper glasses made and worn. 
Often, objections will be raised by parents who think that 
their children do not look so well with glasses, but it is. 
sinful for parents, merely to gratify a foolish pride, to 
permit the children to drift on from' bad to worse. 
School boards should always look upon children with 
defective vision as not up to the standard in i>hysical 
requirements and should not expect the same amount of 
work from them. 

It should be the duty of school authorities to study well 
every condition that would better the scholar's vision. 
The greatest essential is good light : schools with poor 
light show a high percentage of defectiveness, one case, 
where the light was miserable, running as high as fifty- 
nine per cent. The use of slate and pencil is far more 
harmful to the eyes than paper and pencil. The paper on 
which the books are printed should be heavy and without 
gloss. 

The type used, according to Dr. Cohit, should not be 
less than six one-hundredths of an inch in height, and the 



the Schoolroom. 65 

small "n" not less than one one-hundredth of an inch 
wide. The distance between the lines should be not less 
than one-tenth of an inch, nor the distance between letters 
less than three one-hundredths of an inch. 

It is essential that the type employed in books used in 
the first grade be large and distinct, for now for the first 
time the vision of the child is to be confined to a limited 
space. 

We must use two hands to do 
most of these things. 

Fig. 19. * 

The second year, the eye having become habituated to the 
books, the type need not be so large. 

It does not hurt the eyes to use them. 
Indeed, they learn to see better by being 
used, if only they are well treated. 

Fig. 20. 

But in no books supplied for the schools should the type be 
less in size than "Small Pica," which is the type employed 
in this book. 

These matters, however, may be all changed to the 
desirable point, and yet many eyes continue to suffer. 



66 The Hygiene of 

There is a radical fault in the school system, and that is 
in the school programme : It should be changed so that 
the periods of eye-work would be shortened and greater 
time left between. It is a difficult problem to solve, con- 
sidering the ambition of the child, of the parent, and of 
the school authority, but the time must come for a wide 
departure from the present mode of work. The course 
of study should be less compulsory — rather elective to 
suit each individual case, and the amount of work ex- 
pected from each child should be a matter for the physi- 
cian to determine aftc, a careful consideration of motor 
and mental ability. 

Care should be taken about the "extras" imposed upon 
a child, such as private lessons in music, drawing, and 
fancy needle-work, as often such work is especially 
fatiguing to the child's eyes. The home study should be 
inquired into and where the pupil has weak eyes should 
be entirely omitted. 



the Schoolroom. 67 



CHAPTER VIII 
The Hygiene of the Ear 

Next in importance to the eye in the consideration and 
care that it requires is the ear. The percentage of de- 
fectiveness in school children ranges with different ob- 
servers from six to twenty per cent. Careful examination 
of the hearing of a large number of scHbol children in 
Chicago showed that 16 per cent, had perceptible defect 
in one ear or the other, and that 7 per cent, had defects 
of both ears. Children of the age of seven or eight years 
were more prone to show such defects than those of any 
other age. School conditions, however, will not benefit 
or harm the eye in as great a degree as the eye. 

The causes of deafness will be clearer with an under- 
standing of the anatomy of the ear. It consists of three 
portions : the external, the middle, and the internal. The 
external ear comprises, in addition to the part seen on the 
exterior of the head, the passage that leads inward as far 
as the drum-head. The middle portion, or tympanum, 
is a cavity lying beyond the drum-head. From this part 
a small tube leads to the upper portion of the throat, or, 



68 



The Hygiene of 



more properly speaking, the pharynx; this is called the 
Eustachian tube. Three small bones lie in this cavity, 
forming a connection between the drum-head and the 
internal ear. The internal ear consists of chambers and 
tubes hollowed out of the temporal bone. 




FIQ. 21. 

VIEW OF THE HUMAN EAR, AS SEEN ON A SECTION FROM ABOVE 

DOWNWARDS. 

a. The membrane of the drum. d. The cavity of the drmn. c. The 
chain of bones, d. The tube leading into the throat (the Eustachian 
tube), e. The vestibule. /,/. Openings of two of the canals into the 
vestibule. The thin membranous parts in which the nerve is contained 
are supposed to be removed. ^. The cochlea. A. Nerve of hearing. 



the Schoolroom. 69 

Some points should always be borne in mind. Blows 
on the ear are extremely likely, by forcible compression of 
the air in the auditory canal, to rupture the drum-head. 
Even where corporal punishment is tolerated, this should 
not be the method employed. Pulling the ear will some- 
times cause it to ache. At any rate, if a child be slapped 
upon the ear, or be pulled by the ear by a teacher, the 
parent will use that as an attributable cause for any dis- 
turbance that may at any later time arise. Foreign 
bodies in the ear, such as peas, beans, and small pebbles, 
should be let severely alone, as any probing will usually 
push the substance farther into the canal. They can 
safely be removed only by washing out with an ear 
syringe. There is excellent sense in the old adage, 
"Never put anything into your ear smaller than your 
elbow," which is an exaggerated way of advising putting- 
nothing at all into the ear. Teachers should warn pupils 
against introducing penholders, pencils and pens into 
their ear, as being a very dangerous practice. 

A recent invention called the audiometer has been con- 
siderably used in testing hearing and is valuable from its 
simplicity of operation and the exactness of its working. 
It employs an electric current which can be varied at will 
through a fixed scale of intensities, the operation produc- 
ing a series of clicks in a telephone receiver held to the 



70 The Hygiene of 

ear. When this instrument is not available, the most 
satisfactory way of determining the extent of a child's 
hearing is by the ''whispered number" test : a normal ear 
should hear the whispered voice at twenty feet. Seat 
the pupil twenty feet away, with one ear towards the 
person making the test, and the other ear blocked by the 
hand. Be careful to note that the child is not looking at the 
examiner, as it would be difficult to tell how much was 
gathered in by the ears, and how much by sight-reading 
of the lips. Whisper any number at random and ask 
the child to repeat, giving at least ten numbers. If the 
child is unable to hear, or wrong answers are given, 
advance slowly toward the pupil, repeating the number 
in the same manner. Make careful record of the hearing, 
marking it normal if the whisper is heard at twenty feet, 
one-half if heard at only ten feet, one-quarter if at five 
feet, etc. The test should of choice be conducted quietly 
and away from the remainder of the pupils. Sometimes 
the ticking of a watch is used in place of the voice; but 
the number test is preferable, since many pupils, from a 
desire to be considered ''smart," will profess to continue 
to hear the watch long after they are unable to do so. 
The ticking of an ordinary watch should be heard by the 
normal ear, in a quiet room, at a distance of twenty feet. 
The school, as has been remarked, is hardly as account- 



the Schoolroom. 71 

able for bad hearing as for bad eyesight. Many of the 
ear troubles follow infectious diseases; some result from 
colds, enlarged tonsils, chronic catarrh, and adenoid 
vegetations; while others are mechanical in their nature 
and are the result of some foreign body in the external 
ear passages, most often a plug of hardened wax. When 
from the latter source, it can easily be remedied by a 
surgeon. Bad hearing from catarrh is an exceedingly 
difficult matter to treat, but the only time that any pros- 
pect of improvement can be held out is during the school 
age, for usually after this stage the case becomes in- 
curable. 

Deafness due to enlarged tonsils and adenoid growths 
in the naso-pharynx is greatly improved when an opera- 
tion is performed. When due to the above causes, a 
defect in speech is usual and the child breathes with tlie 
mouth half-opened. This condition is known as mouth- 
breathing. The child presents a distracted, expressionless 
appearance, is unable to talk well, to hear well, or to study 
well ; unable to talk well, because the enlarged growths 
in the throat act as foreign bodies; unable to hear well, 
because these same growths block up the Eustachian tube, 
spoken of as running from the throat to the ear; and 
unable to study, because the nose and the throat are partly 
occluded, denying a sufficient amount of air to the lungs, 



72 The Hygiene of 

and causing the same sleepy, tired feeling that poor ven- 
tilation would produce. 

A child with enlarged tonsils or adenoid growths 
speaks always as one would with a severe cold in the 
head. They say *'cobbod" for "common," and "sig" 
for "sing." 

The photographs Nos. 22 and 23 show a child with the 
typical face of a mouth breather from adenoids and the 
change in the entire facial appearance when the offending 
growths have been removed. 

It would be valuable for every teacher to have a 
register kept containing data of each pupil's eye and 
ear capacity. With this knowledge at hand, many that 
are considered stupid would be shown to be only unfor- 
tunate, inasmuch as the avenues to their brain are partly 
blockaded ; they need additional aid instead of censure. 
Those whose hearing is defective should be given seats 
within easy range of the teacher's voice, and should at all 
times be subjects for special consideration and regard. 




Fig. 22. 




FIG. 23. 



the Schoolroom. 73 



CHAPTER IX 
The Vocal Organs 

The voice is the sound resulting from the passing in 
and out of the air over the vocal cords, two folds of 
membrane in the larynx, or upper part of the air passage 
between the windpipe (trachea) and the base of the 
tongue. When the cords are relaxed, the air passes be- 
tween them without sound; but at will the small muscles 
guiding the cords can be set tighter, so that as the air 
passes they vibrate and produce sound. The difference 
in pitch is created by the degree of tension of these cords ; 
when they are loosely set, a low note results; when 
tighter, a high one. With the assistance of the upper 
part of the throat (the pharynx), the cavity of the mouth, 
the tongue and the lips, these sounds are modified into 
spoken words. 

A good voice and the ability to speak clearly and dis- 
tinctly are of such incomparable value in after life that 
especial effort should be made by teachers in training the 
voice. With the advent of the Kindergarten, where the 
child comes earlier than formerly under school training, 



74 



The Hygiene of 



Arytenoid, cart ■' ^.^^ ^^^^.^ 



Tctd 




ar,rUM-e/A 



5w< 'y^onjf'^* 



FIG. 24. 

THE LARYNX AND ADJACENT PARTS, SEEN FROM ABOVE. 



and with the knowledge that the teacher should possess 
of the great improvement persistent effort and patience 
will bring about in the speech of children, the coming 
generation should show decidedly less defectiveness of 
this kind. 

The child is able to talk fairly well by the time he 
reaches the school, having begun usually at from twelve 
to twenty months. Any child at two years of age who is 
not able to talk should be a subject for the physician to 
consider. 



the Schoolroom. 75 

The principal defects noted are stuttering, stammering, 
lisping, drawling, hurried speech, thick and indistinct 
speech. Many of these affections are inherited, and 
usually manifest themselves when the child is from three 
to seven years of age. Careful observers have noted that 
errors of speech are intensified at about the ages of 
second dentition (six to eight years) and of puberty 
(about fourteen years). 

Stuttering and stammering are commonly, but im- 
properly, used as synonymous. Stuttering is defined 
by Dr. H. Gutzman as a spasmodic nervous disorder 
which obstructs the uttering of syllables by spastic con- 
tractions at the stop points for vowels and consonants in 
the articulating tube. The impeded utterance is accom- 
panied by a spasm, usually of the muscles of the face and 
neck, but sometimes involving the muscles of the trunk 
and limbs, and is always further accompanied by great 
nervous embarassment. The difficulty is encountered 
principally with the explosive consonants b, p, t, g (hard) 
and k ; less often with the other sounds. The impediment 
may be complete (as ''bb — oy" for "boy"), or incomplete 

("b-b-b— oy"). 

A stammerer finds difficulty in articulating at all, and 
succeeds only after repeated attempts, while the stutterer 
is able to make sounds, but has trouble with syllabic com- 



76 The Hygiene of 

binations. Either trouble may be of central origin — that 
is, resulting from some disturbance of the speech center 
in the brain — or of peripheral origin consequent upon 
some defect of the respiratory passages. 

Dr. Hartwell, in examining one hundred and thirty 
thousand school children in Boston, found that one thou- 
sand of this number were stutterers, and that the pro- 
portion of boys to girls suffering was as three to one. 

Professor A. Melville Bell, who long studied this ques- 
tion, wrote as follows : '*No part of education is, in gen- 
eral so lightly esteemed as that of first learning to speak 
and read; yet, rightly considered, there is none of more 
importance. The first governess, tutor, or schoolmaster 
should be a model of distinctness in his own practice, and 
should be also intimately acquainted with the physiology 
of articulation, that he may, both by wise precept and 
potent example, mold the plastic mouth to grace and give 
easy play to the delicate machinery of speech. With 
proper initiatory training and school surveillance, stam- 
m'ering and its train of silent errors would be altogether 
unknown." 

Enlarged tonsils, adenoid vegetatisms, hair-lip, cleft 
palate and short tongue-strings are all exciting causes of 
impeded utterance. Hysteria and imitation are probably 
causes in some cases, and nervousness is certainly a great 



the Schoolroom. 77 

excitant in all cases. One pupil, it was noticed, could 
read very well when his back was turned on teacher and 
pupils. Dr. Pershing, of Denver, declares that when 
alone or in darkness the stuttering or stammering habit 
disappears entirely, and it is a matter of common observa- 
tion that undue excitement or embarrassment intensifies 
the defect. 

The treatment of such cases must first be referred to the 
physician, to see if the cause be a removable one. Ex- 
perience shows brilliant results from surgical treatment 
where the cause is peripheral ; less satisfactory results are 
observed when the trouble is of central origin. Given 
a pupil with a speech defect, he should become at once 
a subject for special consideration from the teacher, and 
never should his misfortune be paraded before his fellow 
pupils for ridicule. He should not be called upon for 
special exercises, such as declaiming, until he has had 
sufficient training to give him mastery over his voice. 
Let him follow this primary rule : in speaking, whenever 
the impediment is encountered, stop immediately, compose 
one's self, begin again, and stop each time trouble is en- 
countered. 

A great deal of training should be given privately, and 
the child encouraged to think that persistent efforts on his 
part, when alone, in speaking aloud, will greatly benefit 



y8 The Hygiene of 

him. He should be told of the illustrious example of 
Demosthenes, whose first public speech made him the 
butt of ridicule, on account of his imperfect utterance, 
and who, after months of patient effort, in speaking only 
to the waves on the seashore, mastered the situation and 
becanie one of the greatest orators the world has ever 
known. 

Sir Morrell Mackenzie, the greatest of authorities on 
the human voice, emphasizes the point of early training : 
"If there is any doubt as to when it is best to begin the 
training of the singing voice, there can be none as to 
commencing the education of the speaking voice. It can 
hardly be begun too soon ; in this way faults of production 
and articulation can be prevented, or, as it were, 
'strangled in the cradle,' which in after life can only be 
got rid of with infinite trouble and vexation of spirit. 
Too much stress cannot be laid on the importance of sur- 
rounding a child, even before it can speak, with persons 
whose accents and utterance are pure and refined. The 
Greeks, at their period of highest culture, were keenly 
alive to the necessity of this, and would allow no ser- 
vants near their children, but such as spoke correctly." 

This strong advice is in strange contrast with the per- 
nicious habit many parents have of speaking to their chil- 
dren in a foolish lingo of "baby talk." 



the Schoolroom. 79 

Various other faults of speech will entirely yield to 
proper care. Some children have a rapid, jerky way of 
speaking that mumbles many of the words together ; some 
lisp and drawl ; others have a thick, indistinct tone. All 
departures of this nature should concern the teacher and 
receive her earnest attention. She should correct the 
child over and over again until the proper sounds are 
produced. Owing to individual peculiarities, some chil- 
dren seem incapable of pronouncing such sounds as "r," 
making it 'V," but practice will help greatly. 

On the other hand, many speech defects result from 
congenital defects in the lips, the tongue, fhe soft and the 
hard palate. Hare-lip is a congenital fissure of the lips 
and may extend back through the bony parts of the 
mouth, causing cleft palate. It is a common deformity 
and interferes greatly with proper speech. Such cases 
should be operated on in infancy, long before the patient 
reaches school age; but even in school, it should be re- 
membered, it is not too late to operate successfully. 
Tongue-tie is an affection where the tongue is bound 
down and cannot be protruded beyond the teeth. It is a 
serious drawback to proper articulation, but is easily and 
simply remedied by dividing the tongue-string. Cleft 
palate is an unnatural, congenital opening in the roof of 
the mouth and may involve the soft palate or extend into 



8o The Hygiene of 

the hard palate. The severe forms occasion serious dis- 
turbances. In swallowing, the liquids pass through this 
false opening and out through the nose. As the child 
learns to speak, his articulation is faulty and his voice 
very nasal. Early operation is advisable, before school 
age and preferable before the child has learned to talk. 
When the operation is undertaken late, even if it is suc- 
cessful, the child will have great difficulty in overcoming 
the faulty habits in speaking already acquired. Defec- 
tive and irregular teeth also are an impediment to proper 
enunciation. The teeth of school children often receive 
scanty care, and, as a rule, are in poor condition. Ped- 
ley, of England, examined the teeth of 3,800 school chil- 
dren, and found that 75 per cent, of that number were 
badly affected. The real province of the school author- 
ities in such matters is not great, but much good will 
come from the teachers' suggestions to care for the teeth 
with frequent cleansings with the brush. 



the Schoolroom. 8i 



CHAPTER X 
Relation of Contagious Diseases to the School 

Ordinarily the terms "contagious" and "infectious" 
are used synonymously as referring to diseases com- 
municable from one person to another. There is, how- 
ever, a distinction. Contagious diseases are usually 
transmitted by direct contact, while infectious diseases 
are those borne by water, air or food. Tne distinction is 
a fine one, and for ordinary purposes the term "con- 
tagious" may be used to cover all diseases that are popu- 
larly spoken of as "catching." 

The rules and principles intended for the public 
schools in relation to contagious diseases are just 
as applicable to private, parochial and Sunday 
schools. The Attorney General of the State of New 
York in 1903 rendered an opinion to the effect that 
though the State Health law does not compel 
parochial school authorities to exclude unvaccinated chil- 
dren from attending school, yet the local board of health 
may direct general vaccination, and provide a penalty for 
non-compliance. The opinion, the first one passed upon 



82 



The Hygiene of 



this question, was given as a result of the situation at 
Dunkirk, N. Y. 

The principal diseases to be considered are 
measles, smallpox, mumps, diphtheria, scarlet fever, 
whooping-cough, typhoid fever, chicken-pox, erysip- 
elas, influenza, tuberculosis, typhus fever, and con- 
tagious eye and skin diseases. The diseases enumer- 
ated vary greatly in their contagiousness, some being 
especially violent in their ravages, while others are far 
more inert. 

Dr. Louis C. Parkes has arranged a very comprehen- 
sive table of communicable diseases. 



Class A. 

Contagion, usually 
air borne. 



Smallpox. 
Scarlet fever. 
Measles. 

German measles. 
Mumps. 
Chicken Pox. 



Whooping Cough. 
Influenza. 
Typhus. 
Erysipelas. 
Epidemic pneumonia. 



Class B. 



Yellow fever.* 
Cholera. 



Contagion, usually^ Enteric fever 



air or water borne. 



Dysentery. 
Diarrhoea. 



Diphtheria. 



*Recent discoveries, in 1902, by means of the experiments of Reed, Carroll, Agra- 
monte, Guiteras, and others have proved beyond a reasonable doubt that yellow fever is 
inoculated by the sting of mosquitoes. 



the Schoolroom. 



83 



Foot and mouth disease. 



Class C. 



Contagion, usually -^ 
by inoculation. 

Class D. 
Surface lesion neces- 
sary for contagion < 
air borne or direct- 
ly by inoculation. 



Leprosy. 
Glanders. 
Rabies. 
Vaccinia. 



Erysipelas. 
Pyaemia. 



Opthalmia. 



Tetanus. 



Septicaemia. 



Class E. 
Contagion, air borne 
or by inoculation. 



Tuberculosis. 

Cerebro-spinal menin- 
gitis. 



Scrofula. 
Lupus. 

% 



When a disease presents itself in a community only in a 
few and widely scattered cases, it is spoken of as being 
''sporadic." When a number of cases of a contagious 
disease are found in a community, it is said to be "epi- 
demic." A disease would be "epidemic" when found in a 
community in the following proportions : 



For a population of 



100 5 per hundred. 

500 4 " 

2,000 to 5,000 22i/^ per thousand. 

6,000 to 10,000 16 " " 

20,000 to 50,000 8 per ten thousand. 

50,000 to 100,000 4 " " 

200,000 and over i " " 



84 



The Hygiene of 



Most of the contagious diseases are caused by germs 
entering the system, muhiplying and thriving and by 
their presence causing the particular ailment. The space 
of time elapsing between the entrance of the infection 
and the manifestation of the disease is known as the 
"period of incubation." It varies as follows : 



Disease. 



Smallpox. 



Chicken-pox. 



Measles. 



German measles. 



Scarlet fever. 



Diphtheria. 



Period of 
Incubation. 



II to 14, usual- 
ly 12 days. 



7 to 14, usually 
12 days. 



10 to 14, usual- 
ly 10 days, 



7 to 1 5, usually 
14 days. 

I to 7, usually 
3 to 4 days. 



2 to 10, usually 
2 to 3 days. 



Appearance of 
Eruptions. 



Second or third 
day on face or 
forehead. 

First to fourth day 
of fever, on trunk 
and shoulders. 

Fourth day of 
fever, on fore- 
head. 



First to fourth day 
fever, on face. 

Second day of 
fever, on trunk. 



No eruption; rash 
sometimes on 
second or third 
day of fever. 



Period of Infec- 
tion. 



Three to seven 
weeks. 



Four weeks ; un- 
til every scab 
has fallen. 

During initial 
symptoms and 
until end of des- 
quamation. 

Same as measles. 



End of desquama 
tion and com- 
plete disappear- 
ance of throat 
symptoms. 

Until all dis- 
charges have 
ceased and 
throat symp- 
toms have dis- 
appeared. 



the Schoolroom. 



85 



Disease, 



Whooping 
cough. 



Typhoid fever. 



Yellow fever. 



Mumps. 



Period of 
Incubation. 



4 to 14, usually 
7 days. 



I to 26, usually 
12 days. 



I to 7, usually 
3 to 4 days. 



14 to 21 days. 



Appearance of 
Eruptions. 



No eruption. 



Sometimes spots 
on abdomen be- 
tween sixth and 
fourteenth days. 

Jaundice some- 
times on second 
day of fever. 

No eruption. 



Period of Infec- 
tion. 



During catarrhal 
stage and as 
long as whoop 
lasts. 

Until diarrhoea 
ceases. 



Uutil fever ceases. 



Until swelling has 
disappeared. 



Usually the child that has received the infection re- 
mains at school while the disease is breeding. 

Certain of the diseases enumerated have a character- 
istic eruption, viz.: smallpox, chicken-pox, scarlet fever, 
and measles. These are known as the eruptive fevers. 
The time elapsing from the first symptoms of illness to 
the breaking of the eruption, or ''rash," is spoken of as 
the period of "invasion." With smallpox it is from two 
to three days ; with measles, four days ; with scarlet fever, 
two days ; with chicken-pox, one or two days. 

Thanks to the great discovery of vaccination by Ed- 
ward Jenner in 1798, smallpox has not now the important 



86 The Hygiene of 

place in the list of school diseases it once had. Living 
in this generation, almost freed from this horrible plague, 
we can hardly picture the devastation this disease 
formerly caused. Macaulay, the English historian, called 
smallpox "the most terrible of all the ministers of death." 
Professor Wernher, in his work "Zur Impffrage," says : 
"Before the introduction of vaccination, smallpox had 
become a permanent disease which never entirely ceased 
in any one year, and every three or five years became a 
great epidemic. In non-epidemic years, one-tenth of all 
mortality was from variola; in epidemic years, one-half. 
Very few men escaped smallpox till old age; almost 
every one sickened at least once in his life of this hor- 
rible, murderous disease. Countless mortals were maimed 
by loss of sight. Of new-born children, one-third died 
of smallpox before their first year; one-half before their 
fifth year of life. There was no family which had not 
had heavy losses to deplore. Men accepted the pest as 
an unavoidable fate. It was the principal factor which 
deterred or kept back the population from progress; yet 
the efforts of nmny ignorant mortals are directed toward 
a return to these conditions." Looking at present con- 
ditions, the same author says : "We now find no child 
mortality among vaccinated children; among adults also, 
whenever vaccination and revaccination are maintained, 



the Schoolroom. 87 

mortality from smallpox is at an end." That vaccination 
does prevent is shown by Prussian statistics of the approxi- 
mate average annual rate of deaths from smallpox per 
million before the practice of vaccination and after. Be- 
fore the introduction of vaccination the rate was 3,321 ; 
after, only 56. 

An inspector of contagious diseases in New York said : 
''During our nine years of service in the Health Depart- 
ment of New York, I have never seen a case of small- 
pox in a person who had been vaccinated successfully 
within five years, and the number of c^es I have seen 
mount into hundreds. During that period, I have seen 
only one inspector contract smallpox, and he was the only 
inspector who disbelieved in vaccination and refused to 
have it performed upon himself." 

Drs. W. M. Welch and Jay F. Schamberg (Philadel- 
phia Medical Journal) give their experience in the Phila- 
delphia Hospital for Contagious Diseases. They state that 
since the beginning of the year just past (1901), about 
three hundred cases of smallpox were treated at this hos- 
pital. Of this number not a single patient had been re- 
cently successfully vaccinated. The shortest period 
elapsing between a successful vaccination and the con- 
traction of the disease was five years. In this case, 
which occurred in a boy of eleven years old, the eruption 



88 The Hygiene of 

consisted of only a score of papules, which scarcely de- 
veloped into vesicles, and dried up in a few days. It 
was not found necessary to confine the lad to bed. While 
the majority of the patients admitted were unvaccinated, 
a very large number had been vaccinated in infancy. To 
the best of the writer's knowledge, none, save the boy 
mentioned, had been successfully vaccinated within the 
past ten years. The writers beHeve that it may be laid 
down as a rule that if a child be successfully vaccinated 
in infancy, and again at the age of puberty, the protection 
will be permanent. The exceptions to this rule, how- 
ever, may be sufficiently frequent to warrant a repetition 
of the vaccination whenever there is exposure to small- 
pox. They prefer the glycerinated lymph in such cases. 
Smallpox seldom manifests itself in the school, and 
the only phase of this subject of interest is that of vac- 
cination. Immunity from smallpox in recent years has 
made the people careless and even defiant of the laws 
governing vaccination. The "anti-vaccinationists" have 
in many places defied the school authorities who de- 
manded compulsory vaccination among school children. 
It is strange that such a blessing can be so lightly looked 
upon ; and it usually requires several cases of smallpox in a 
community before the people will avail themselves of the 
opportunity to be vaccinated. It should be borne in mind 



the Schoolroom. 89 

that vaccination and modern sanitary science have ahiiost 
wiped smallpox from the face of the earth, and that any 
relaxation of the means that secured this desirable end 
may serve to bring back the scourge once more. All 
children should be vaccinated before entering school, 
unless the health officer can satisfy himself that the state 
of the child's health is such as would make the operation 
inimical to him. 

Compulsory vaccination is demanded by most school 
boards and state laws. A number of complaints, how- 
ever, have been noticed within the pasj two years, of 
laxity on the part of school boards in relation to the vac- 
cination laws. In many cases it is because the parents 
do not believe in efficacy of inoculation, or because they 
fear some evil result. But the proverbial vaccination 
stories, telling of horrible results, are gross exaggera- 
tions, not to be credited, as in not one case in a thousand 
are any untoward results noted. 

School boards should always require each child upon 
entering the schools to be successfully vaccinated. This 
means that if the inoculation fails to "take" at the first 
trial, it should be repeated again and again until it 
does "take." Usually the certificate given to a success- 
fully vaccinated child when entering school is allowed 
to stand indefinitely ; but as the immunity is supposed to 



90 The Hygiene of 

disappear in from five to seven years, revaccination 
should be insisted upon from time to time. 

When smallpox is epidemic in a community all the school 
children should be vaccinated regardless of previous 
scars. If the immiunity still continues, the vaccination 
will have no effect, and if successful it only proves the 
necessity of the added safeguard. There may be some 
few children in a community who, for physical reasons, 
should be excused from vaccination; but the number 
rightfully excluded would be very small. Pressure is 
often brought to bear upon the physician by the parent 
for a certificate of exemption, and it would be wise for 
school boards to demand the signature of two physicians 
to such a certificate. 

The U. S. Marine Hospital Service, in its bulletin (Hi 
"Smallpox," decries the necessity at all of such exemp- 
tions and pointedly says that there are only two classes in 
a community who deserve to be exempt — ''first, those that 
have already had smallpox, and, secondly — those that are 
dead." 

Chicken-pox is a harmless disease which has interest 
only from its liability to be mistaken for smallpox. It 
manifests itself in the shape of small, round rose-colored 
sores scattered over the body. But however mild it is in 
its nature, no child suffering from it should be allowed 
at school. 








o i:: 



1 




-■■ .^ • «*-. J* vs* ^ 




FIG. 28. 

Measles. 



the Schoolroom. 91 

The three great ''school diseases" of this dime, both 
because of their frequency of appearance and the serious- 
ness of their nature, are measles, scarlet fever, and diph- 
theria. This does not mean that they are serious because 
they always destroy life, but because of the troublesome 
after-effects they leave upon the eyes, the ears, and the 
voice. 

Measles, though the least likely to be fatal, is the most 
infectious of all, beginning to be so several days before the 
eruption breaks out. A child coming down with it 
exhibits symptoms of a severe cold; has headache, stop- 
page of the nose, tickling of the throat, sneezing, in- 
flamed, watery eyes, and a hard, dry cough. The erup- 
tion is in the shape of small, red dots resembling flea 
bites, first appearing on the temples and the forehead, 
and later spreading over the entire body. Pneumonia 
often complicates a case of measles, making a serious 
combination. A lingering cough or inflamed eyes and 
ears may follow. The patient should keep his bed for a 
week and his room for three weeks. If well by this time, 
he may rejoin his playmates. When a case enters a 
household where other children are, all should be enjoined 
from attending school. Epidemics of measles usually 
begin in cold weather. (See fig. 28.) 

Scarlet fever, or scarlatina, is a limited contagious 



92 The Hygiene of 

disease caused by a specific germ, and characterized by 
fever, sore throat, and an eruption. This eruption is of 
a bright scarlet, forming first on the chest and the upper 
extremities. About the fifth day of the fever, the rash 
begins to peel off, and then especial care should be taken, 
as at this time the disease is most infectious. Contagion 
may come through such mediums as library or school 
books, letters, clothing, or toys. Chronic nasal catarrh, 
pneumonia, heart and kidney trouble, may complicate and 
follow this disease, but what is most of all to be feared is 
the ear trouble, where the drum-head becomes perforated 
and a chronic discharge follows. One observer, upon 
investigating causes of deafness in four hundred persons, 
found scarlet fever to be responsible for one hundred and 
forty- four of that number. A' child should not be al- 
lowed to return to school until four weeks after recovery, 
as the disease continues to be infectious long after the 
patient is apparently restored to health. (See fig. ^:) j 
Of the common diseases incident to school life, diph- 
theria is the most destructive. In recent years, the dis- 
covery and use of antitoxin have considerably lessened 
the mortality, but it is still a difificult disease to combat. 
Its duration is usually short and its progress rapid. Its 
constant feature is the presence of a white patch or 
patches in the throat, accompanied by high fever and 



'^pl«^«l«^ 






FIG. 29. 

Diphtheria. 




FIG. 30. 

Scarlet Fever. 



the Schoolroom. 93 

weakness. Many cases are of such slight nature and the 
constitutional symptoms so light that little notice is paid 
to the affection by careless parents, and the child con- 
tinues at school, infecting all about him. Peculiarly 
enough, however, the mildest case of this disease may 
infect another child with the most violent type. (See 

fig. .30-) : 

If there should be no medical inspector connected with a 
school, it is an easy matter for the teacher, in all cases 
of "sore throat" coming under her notice, to make an 
examination by depressing the back portion of the 
tongue with a small, clean piece of wood. If there are 
shown in the throat any small white spots or patches, the 
child should be immediately sent home to be examined by 
a physician. It is true that white patches in the throat 
do not always indicate diphtheria, but the teacher should 
not be expected to differentiate. That can best be done 
by a physician, and then only after a culture is taken 
from the throat to be examined under the microscope for 
the detection of the presence of diphtheria bacilli. Diph- 
theria patients should be carefully isolated and pupils 
from the same family kept from school. The child may 
be returned to school, if good disinfection has been car- 
ried out, three weeks after recovery. 

Whooping-cough is a disease far too lightly considered 
both at home and at school. Ordinarily, little attention 



94 The Hygiene of 

is given to it by the school authorities. Children are 
often allowed to con'tinue at school while suffering from 
it, infecting those around them at every cough, and an- 
noying all present by each spasmodic outburst. And, 
although in most cases the child recovers, whooping- 
cough is far more dangerous than is usually supposed. 
Dolan ranks it third among the fatal diseases of child- 
hood in England, and Smith, in New York, states that 
one out of every seventynsix deaths there is due to whoop- 
ing-cough. It is not alone in the disease itself that the 
mortality lies, but in the complication so often resulting, 
such as convulsions and pneumonia. Children with this 
disease should be kept from school until the physician 
certifies to complete recovery. Unfortunately, the dis- 
ase is a long-standing one, running from six weeks to 
as many months, and parents will protest strenuously 
against having the child excluded from school for this 
long period of time. There is no alternative, however, 
when we consider the extreme contagiousness of whoop- 
ing-cough and the great distress the infliction of the 
disease on others would cause. 

Tuberculosis, or, as it is popularly called, consumption, 
is sometimes encountered in the schoolroom. Since the 
discovery by Koch of the cause of tuberculosis, the con- 
viction of late years has grown that this disease is com- 



the Schoolroom. 95 

municable and to a great measure preventable. With a 
view to preventing the spread of tuberculosis, the Board 
of Health of New York City issued the following in- 
struction : 

"Consumption is a disease which can be taken from 
others and is not simply caused by colds. A cold may 
make it easier to take the disease. It is usually caused 
by germs which enter the body with the air breathed. 
The matter which consumptives cough or spit up contains 
these germs in great numbers : frequently millions are 
discharged in a single day. This matter, spit upon the 
floor, wall, or elsewhere, is apt to dry, become pulverized, 
and float in the air as dust. This dust contains the 
germs, and thus they enter the body with the air breathed. 

"The breath of a consumptive does not contain the 
germs and will not produce the disease. A well person 
catches the disease from a consumptive only by in some 
way taking the matter coughed up by the consumptive." 

A child known to be suffering from tuberculosis must 
of necessity be excluded from school. With this disease 
the outward signs noticeable to a teacher would be 
cough, paleness of the skin, difficulty of breathing, and 
weakness. Any pupil who continues to cough for some 
time should be examined and a physician's opinion be 
requested as to whether the trouble is contagious. Ex- 



96 The Hygiene of 

pectoration upon the floor should be forbidden at all 
times, whether a cough be present or not. 

Mumps, or parotitis, is an acute infectious disease, 
outwardly manifested by swelling of the parotid gland, 
which lies immediately below the external ear. Mumps 
will be encountered in the schoolroom more often than 
any of the diseases previously spoken of, as the child 
usually complains but little of sickness, and the infectious 
nature of the ailment is not rightly recognized. It is not 
dangerous to life, but should be guarded against by re- 
fusal to admit any child suffering from this disease. 

Typhoid fever is very apt to manifest itself during 
school life, as a large number of cases occur between the 
ages of five and fifteen. Besides being an especially 
dangerous disease, it deprives the child of the advantages 
of school for a long period of time, often many months. 
It is known to be contagious, and often the avenue of the 
disease is polluted milk or drinking water. If the water 
of a school is from the public water supply of a city, 
there are authorities who are supposed to analyze it care- 
fully from time to time for the presence of any disease- 
breeding impurities. If the supply be on the grounds, 
from a well, it should have a careful analysis at least 
twice a year to determine its purity. 

Should two or three or more cases of typhoid fever be 



the Schoolroom. 97 

reported from a single school, the closest examination 
should be given to the building, lest the cause should be 
there. The water supply, the drainage, the closets, and 
the cellar, should be the subjects for investigation. 

Typhus fever, cerebro-spinal meningitis and erysipelas 
are contagious diseases which it will usually require a 
physician to discover. When epidemic, they require the 
same precautions as spoken of with the foregoing dis- 
eases. 

Certain inflammatory diseases of the eye and skin are 
contagious. Any child found with sore, watery eyes, or 
scabby sores upon the body, or that peculiar skin disease 
known as "ringworm," should be sent out as being a 
subject of a contagious disease. 

The diseases described are all, to a greater or less 
extent, communicable, and also largely preventable. No 
greater good can be done in school work than by the 
study and application of hygiene to prevent these same 
diseases, which annually make such ravages among chil- 
dren. The school is and should be looked upon as a 
beneficent institution, boding only good to those who 
enter. How often, though, physicians are compelled to 
draw aside the curtain and see a different picture ! For 
the school must always be a danger field. It is the com- 
mon meeting-ground for all. The child whose mother 



98 The Hygiene of 

is forever scouring him must rub shoulders with a neg- 
lected child suffering with vermin and itch. At home a 
child may drink only from his own cup, and at school 
drink from a filthy tin dipper that a hundred lips have 
touched that day. The wonder is that disease is not more 
common in our schools. It behooves us, then, to study 
all conditions that will serve to lessen this great inter- 
change of disease. 

First, we must revert to ventilation again, and con- 
sider that disease germs find a paradise in a close, poorly 
ventilated room. AboHsh the common drinking cup. 
It should not be tolerated for one day in a schoolroom. 
Each child should have a marked cup of his own and use 
that only. 

An admirable means of preventing the spread of many 
diseases is by the substitution for the drinking cup or tin 
dipper of a drinking fountain, which has been patented, 
by means of which the pupil, pressing a small 
lever in the floor with the foot causes a gentle stream of 
water to be thrown upwards. The child places the lips 
to this stream and drinks; the water flows back into a 
basin and out. Removal of the foot from the lever stops 
the supply of water. The great advantage is that the child 
drinks readily and without touching the lips to any cup or 
dish of any kind. This appliance in actual use is shown 




Fig. 27. 

Sanitary Drinking Fountain in use. 




FIG. 26. 

Sanitary Drinking Fountain. 



the Schoolroom. 99 

in illustration opposite. Too much cannot be said for 
this device; its general use would undoubtedly cause a 
marked diminution of contagious diseases. 

The pupil should be enjoined from the very common 
practice of wetting the thumb or fingers with saliva to 
turn the leaves of a book. This is an unsanitary practice 
and an easy way of introducing disease germs into the 
mouth. 

The practice of carrying home books or other school 
articles should be carefully looked after and forbidden in 
cases where contagious diseases exist. If, by some over- 
sight, such articles are left at homes where there are such 
diseases, they should be thoroughly fumigated with for- 
maldehyde vapor before they are returned to the school. 
When smallpox, diphtheria, or scarlet fever is epidemic in 
a community, the carrying of any articles from school 
to home should be prohibited. 

The use of pencil and slate is rapidly passing away, 
and the pad of paper and lead pencil are being substituted. 
It is impossible to keep the old slate clean, and usually 
the attempted cleaning is done with saliva. Its use also 
involves the necessity of sponges and slate cloths, which 
are ready germ catchers. 

No common towel should be used at school. Con-^ 
tagious skin and eye troubles find a ready mode of inter- 



loo The Hygiene of 

change through the towels. If they are at all necessary, 
there must be one for each pupil. Schools that are in use 
both day and evening demand extra care in regard to 
ventilation and cleanliness. 

When a severe epidemic visits a particular school, 
neighborhood, or city, there should be no hesitancy in 
closing the schools. This, as has been proved time and 
time again, will usually suffice to stop the spread of the 
disease. Dr. Walford, an English medical officer of 
health, says : "I am aware that it is frequently stated that 
on the closure of schools, children will play together in 
the streets or meet in houses, and that the epidemic will 
thus spread still more. Doubtless under these circum- 
stances, there is a probability of some infected children 
coming in contact with healthy ones, but the danger of 
spreading the infection must be infinitely greater when 
a large number of children are congregated together for 
hours in overcrowded and badly-ventilated schoolrooms." 

If, during the prevalence of an epidemic, the schools 
are not closed, it is feasible and advisable to fumigate the 
rooms often by the use of formaldehyde vapor. This 
can easily be done by the janitor after school hours. The 
use of disinfectants such as a solution of carbolic acid 
(one part to fifty parts of water), mercuric chloride (one 
part to a thousand parts of water), and permanganate 



the Schoolroom. loi 

of potassium (one part to a thousand parts of water), 
about the water-closets is always advisable, and especially 
so in epidemics. Many janitors place too much reliance 
on disinfectants, and think that no matter how filthy a 
corner may be, liberal sprinkling of chloride of lime, or 
some such agent, will immediately purify it. The best 
disinfectant is cleanliness, which should always be the 
advance guard of the other means employed. 

Schools that have the benefit of the daily examination 
of the medical inspector are indeed fortunate, as the 
burden of a great responsibility is taken from the teach- 
ers. In schools not so fortunate, the teacher should make 
careful daily inquiries regarding the health of the pupils 
and also the health of the other inmates of the pupils' 
household. In this way many contagious diseases will 
be discovered and reported to the proper official for in- 
vestigation. Many families treat, without a physician's 
aid or any attempts at isolation, such diseases as diph- 
theria, measles, and scarlet fever, often being afraid to 
report to the Health Board, lest the laboring members 
of the family will be denied their usual work. 

Every school board should adopt careful and stringent 
regulations regarding contagious diseases and the school. 
The Health Board of the City of New York has approved 
a number of recommendations suggested by Professor 



I02 The Hygiene of 

Herman M. Biggs, the department bacteriologist, and 
ordered that a copy be sent to the Board of Education. 
Some of the recommendations are as follows : 

''i. The use of slates, slate pencils, and sponges shall 
be discontinued in all the public schools. 

"2. According to requirement, pupils shall be supplied 
with pencils and penholders, each pupil to retain those 
received in a box provided for the purpose, such box to 
be marked v/ith the pupil's name. Pencils and penholders 
shall not be transferred from one pupil to another without 
suitable disinfection. 

''3. All school property left in the school building by a 
child sick with any contagious disease, and all such prop- 
erty found in r,n apartment occupied by a family in which 
a case of smallpox, typhus fever, diphtheria, scarlet fever, 
or measles has occurred, shall be taken by the Health 
Department for disinfection or destruction. 

"4. Books which are taken home by pupils shall be 
covered regularly once a month with brown manila paper. 

''5. Places for drinking water on the ground floors of 
the school buildings shall be discontinued, and a covered 
pitcher provided for each classroom, in which fresh water 
shall be placed before every session. A numbered cup to be 
kept in the classroom shall be issued to each pupil. No 
interchange of cups shall be allowed. 



the Schoolroom. 103 

"Provision is proposed for the exclusion of children in 
whose homes there may be cases of contagious disease, 
and for a report by teachers to the Board of Health of all 
cases of sickness among the pupils. Finally, the recom- 
mendations provide for more closet room for hanging 
clothes, and prohibit principal and teachers from sending 
one pupil to the house of another for any reason." 

Teachers or the medical officer should teach the pupils 
the great advantages of daily bathing and the immunity 
from contagious diseases it affords. The medical director 
of a boys' boarding school in England stated that the 
daily practice of head to foot bathing in his^chool reduced 
infectious diseases to one-third of the number previous 
to the establishment of this practice. In some schools 
instruction must go still farther; children should be en- 
couraged to be clean in person and clothes, especially the 
underclothes. So much of disease is given off by the 
skin and so much disease finds its way into the body 
through the skin that it is essential for a healthy body to 
have a clean, active skin. This cannot be had when 
changing of underclothes is neglected and accumulated 
dirt blocks up the small invisible pores of the skin. 

Often a teacher may wish to know whether a complain- 
ing child is really ill or only affecting to be so. During the 
presence of an epidemic it would be wise for the teacher 



I04 The Hygiene of 

to take the temperature and pulse of the child. To obtain 
the temperature, or bodily heat, it is necessary to have a 
small clinical thermometer, the bulb of which is placed 
underneath the tongue, with closed lips, and allowed to 
remain there three minutes. Nominally, when removed 
it should be 98.2^F, and any elevation of this should be 
noted and the child sent home. When a thermometer is 
used, it should first be thoroughly cleansed and shaken 
so that the mercury will stand lower in the column than 
the normal point. The normal pulse of children of school 
age will vary in health from 72 to 80. 



the Schoolroom. 105 



CHAPTER XI 

Medical Inspection of Schools 

Among the diseases known commonly as ''school dis- 
eases," some have been discussed as being contagious, 
others as non-contagious ; but all are to a greater or less 
extent preventable, either by discovery and isolation or 
by better application of hygienic detail. Within the last 
decade, in the larger cities of this country and Europe, 
the plan has been adopted of having a regularly appointed 
medical officer, whose duties are a daily examination of 
all suspected illness, whether contagious or not ; a regular 
examination of the child's sight, hearing, and seating; 
and an investigation as to proper heating and ventilating 
of the schoolroom. At first some objections were raised 
to the adoption of such a practice. The expense was de- 
plored, but in most instances the fees of the inspector 
were fixed at a merely nominal sum of one or two hun- 
dred dollars a year. Some physicians selfishly objected, 
protesting that the discovery of some of the ''school dis- 
eases" would serve only to enlarge the practice of the 
inspector; but the rules formulated gave the inspector no 



io6 The Hygiene of 

authority to prescribe medicines. The child was sent 
home and the case treated by the family physician. Being 
a new thing, it, like many other innovations beneficial to 
the people, was looked upon by some with little favor. 
But its establishment in a city meant always its retention, 
for the benefits derived were conspicuous and the only 
wonder was at the folly of having lived so long without it. 
In Boston, for the first fourteen months of medical 
inspection, 16,700 cases were examined, and during 
that time were discovered "j^j cases of diphtheria, 28 
of scarlet fever, 116 of measles, 28 of chicken-pox, 
69 of pediculosis (lice), 47 of mumps, 33 of whooping- 
cough, 47 of scabies or contagious itch, 8 of con- 
genital syphilis, a large number of contagious dis- 
eases of the eyes, and 2,000 cases of follicular tonsilitis. 
According to the report of the health department of the 
city of Boston for 1900, there were examined by the 
medical inspectors of the public schools 15,573 children. 
Among these the following diseases were found : 

Specific infectious diseases 505 

Oral and respiratory diseases 2,609 

Diseases of the ear 37 

Diseases of the eye 431 

Diseases of the skin 3j42I 

Miscellaneous diseases. 3>568 

Found free from disease 4>952 

15,573 



the Schoolroom. 107 

Of the infectious diseases, there were: Diphtheria, 2^ 
cases; scarlet fever, 23; measles, 121; whooping- 
cough, 62 \ mumps, 107; chicken-pox, 108; influenza, 50; 
erysipelas, 2; syphilis, 3; tuberculosis, 2; malaria, 4. 
There were 438 cases of acute pharyngitis, 1,281 of acute 
follicular tonsilitis, 58 cases of adenoid disease, 220 cases 
of imperfect eyesight (without visible cause), 337 cases 
of eczema, 227 of impetigo contagiosa, 2,316 of pedi- 
culosis (lice,) 42 of scabies (itch) ; of tinea favosa and 
tinea trichophytina (ring- worm), 172; of headache 
(habitual), 206; of urinary diseases, 29. 

In New York city, during the first four 3ays of medical 
inspection in the public schools, 400 cases of contagious 
disease were discovered and dismissed from school until 
danger from contagion had passed. The report of the 
results of medical inspection of the public schools in New 
York city shows that for the quarter ending June 30, 
1897, there were 220 schools inspected each day by 149 
medical school inspectors. The total average attendance 
was 149,520. Of this number, 63,812 children were 
examined as siuspects, of whom 4,183 were found to be 
affected with some contagious disease and excluded from 
the schools. This makes over six per cent, of the total 
examined. Of these cases of contagious diseases, 167 
were cases of diphtheria; 32 scarlet fever; 88 measles; 



io8 The Hygiene of 

II croup; 26 whooping-cough; 117 mumps; 702 con- 
tagious diseases of the eye ; 2,627 parasitic diseases of the 
head, 108 of the body; 130 chicken-pox; 175 skin diseases. 

Of the true cases of measles and of scarlet fever all 
were in the stage of desquamation. This would naturally 
be the case, inasmuch as these diseases, in the beginning, 
are marked with a certain amount of fever and discomfort 
which leads the parents to retain the children at home, 
after which the rash appears, and the case is then ex- 
ckided from the schools. But there are certain cases in 
w^hich the constitution of the patient is such that the 
fever is unappreciable ; and the child, having a slight 
rash only, is given little notice by the parents, and con- 
tinues at school until desquamation occurs, when probably 
a new crop of cases will be produced. ' 

To quote the report : ''As a rule, among a large num- 
ber of people having children that attend school, no 
dread of these diseases, so common to childhood, is felt; 
and either through indifference or selfishness they refuse 
to believe that these diseases are avoidable, and often 
oppose the use of the proper means for their prevention. 

''A glance at the totals of the various diseases for which 
children have been excluded during the sixty-five school 
days of the past three months shows the carelessness and 
ignorance of many parents in regard to the spreading of 



the Schoolroom. 109 

infectious and contagious diseases. Not thinking of, and, 
perhaps, not caring about, the danger, they send their 
children, carrying the germs of these diseases, into the 
crowded schoolroom, and necessarily expose and, no 
doubt, infect many other children. 

"These results also show the importance of the med- 
ical school inspection as one means of preventing the 
spread of these diseases; and with this work further ex- 
tended and perfected, and with the education of the 
parents and guardians as to the necessity of keeping in- 
fected children at home, we shall be able to reduce the 
number of these diseases among the children of this city." 

From statistics gathered from medical inspectors' re- 
ports in Berlin, New York, Boston, and Chicago, it ap- 
pears that about six to twelve per cent, of the pupils 
attending the average public school are suffering from 
some one or other of the diseases enumerated, and 
are a source of danger to those with whom they come in 
contact. The medical profession has co-operated to the 
extent of giving its services at a very moderate figure : 
no school, then, in this broad land should be without a 
medical officer. It needs no stretch of imagination to 
believe that if this practice is made general, thousands 
of lives of children will be saved, and thousands by this 
protection be spared the ordeal of long periods of illness 
and the enforced loss of valuable time at school. 



no The Hygiene of 

Dr. Reynolds, health commissioner of Chicago, says 
that he knows of no other single living effort in which his 
scanty force of inspectors has engaged that has been of 
more obvious and direct benefit to the community in gen- 
eral, as well as to the school children themselves. 

In Berlin, after a serious epidemic of measles which 
paralyzed for a time the school system, public meetings 
were held; and the following resolutions were adopted 
and afterwards put into practice: 

"Laymen and physicians demand that each school have 
a physician assigned to it, to have charge of the general 
hygiene of the building and be watchful over the health 
of scholars; to see to the proper heating, ventilation, 
cleanliness, and, if necessary, disinfection of the building ; 
to order the closing of the school when the heat becomes 
excessive, and in times of epidemics; furthermore, to 
examine new scholars ; in short, the physicians should 
protect the scholars against the dangers of school life." 

Dr. Samuel H. Durgin, chairman of the Boston Board 
of Health in 1897, describes the working of the system in 
Boston. The Board of Health divided the city into fifty 
districts, giving an average of about four schoolhouses 
and fourteen hundred pupils to each district. No diffi- 
culty was experienced in finding well qualified and dis- 
creet physicians who would undertake the duties pre- 



the Schoolroom. 1 1 1 

scribed, and the board selected and appointed a piiysician 
for each district with a salary of $200 a year. His duty 
is to make a visit to each master's school daily, soon after 
the beginning of the morning session. The master re- 
ceives from the teachers in his district early reports as to 
the appearance of illness in any pupil in their charge; 
these reports are given to the visiting physician, who at 
once examines the reported children and makes a record 
of his diagnosis and action in books furnished by the 
Board of Health for this purpose and kept in the custody 
of the master. If the visiting physician finds the child 
too ill, from any cause, to remain in school, he advises the 
teacher to send the child home for the observation and 
care of its parents and family physician. If the illness 
is from a contagious disease, the child is ordered home 
and the case reported to the Board of Health. The dis- 
position of the sick child while at home and the proper 
isolation in cases where contagious diseases develop in 
such children, as well as the giving of a warrant for re- 
turning to the school, depend principally upon the report 
of the school inspector. 

The Health Department of New York City has the 
best and most specific rules for the medical inspectors. 
They are as follows : 

"Inspectors are required to report at the schools to which 



112 The Hygiene of 

they have been assigned from 8.50 to 9.30 a. m. every 
day that school sessions are held. They are to examine 
carefully each child that has been isolated by the teachers 
in charge, and cause to be excluded from school each 
one affected with, or showing symptoms of, any con- 
tagious or infectious disease, more especially the follow- 
ing: measles, diphtheria, scarlet fever, croup, whoop- 
ing-cough, mumps, contagious eye diseases, parasitic dis- 
eases of the head or body, or chicken-pox. They shall 
furnish each pupil that is to be excluded with a printed 
card, upon which they shall note the date, name, and 
location of the school, the name, age, and address of the 
child, and the reason for the child's exclusion. These 
cards, signed by the medical school inspectors, are to be 
taken home by the excluded pupils. Each day, before 
leaving a school, each inspector is required to fill out a 
printed daily report blank, giving the date and time of 
visit, the name, location, district and card numbers of the 
school, the number of children examined (male, female, 
and total), the full name, age, and address of each one 
excluded, and the diagnosis of each excluded case. Note 
is also to be made on the daily report of any bacterial 
culture that has been taken, giving the clinical diagnosis, 
and stating whether the pupil was excluded or not. On 
the last school day of each week, the printed sum- 



the Schoolroom. 113 

mary blank, on the back of the daily report blank used 
that day, is to be properly filled out for each school day 
of that week. Each day, as soon as possible after leaving 
the last school to be visited, inspectors are required to 
mail a separate daily report (properly folded and 
"backed") for each school visited, to the chief inspector 
at the central office, where a daily summary is made of 
the- work performed in all the, schools visited. 

All children excluded from school for measles or scar- 
let fever are visited at their homes within twenty-four 
hours by one of the diagnosticians of the board, and such 
cases are not tabulated as true ones unless he confirms 
the diagnosis, when a department postal card is sent to the 
school, excluding the child until after his complete re- 
covery. When the necessary disinfection and fumigation 
of the rooms where the child lives have been attended 
to, a certificate allowing him to return to school is issued. 

Pupils excluded for chicken-pox are visited at their 
homes by the medical inspectors of the Division of Con- 
tagious Diseases having charge of the districts in which 
the children live; when they confirm the diagnosis, the 
cases are recorded as true ones, and the schools notified 
by department postal cards. 

In cases of suspected diphtheria, when there is well- 
marked clinical evidence in the throat at the time of the 
examination, the child is to be excluded, after a culture 



114 The Hygiene of 

has been taken; when the cHnical evidence is not well- 
marked, a culture is to be taken, but the child is not 
to be excluded until a report is received by the medical 
school inspector from the Division of Bacteriology, stat- 
ing that an examination of the culture shows the presence 
of the Klebs-Loeffler bacilli.^ In each case where an ex- 
amination of a culture taken by a medical school inspector 
shows the presence of the Klebs-Loeffler bacilli, a notice 
to that effect is promptly mailed to the maker of the cult- 
ure, and also to the medical inspector of the Division of 
Contagious Diseases in whose district the child resides, 
who then takes charge of the case as far as the proper 
isolation is concerned, taking subsequent necessary cult- 
ures, ordering disinfection and fumigation when the 
Klebs-Loeffler bacilli have disappeared from the throat, 
and issuing certificates for the child's return to school. 

The district medical inspectors have the same surveil- 
lance over each case of measles or scarlet fever where the 
diagnosis made by the school inspector has been con- 
firmed by a diagnostician. When the result of an ex- 
amination of a culture, made by a school inspector, is 
negative, a report to that effect is forwarded to the chief 
inspector, but not to the maker of the culture. When the 
examination of a culture made by a school inspector does 

* The Klebs-Loeffler bacilli is the germ that is the recognized cause of diphtheria. 



the Schoolroom. 115 

not admit of an exact bacteriological diagnosis, and a 
prompt confirmatory culture is requested, such request is 
mailed to the maker of the culture, and also to the district 
medical inspector, in order that a confirmatory culture 
may be taken by the former, if the child is at school, or 
by the latter, if the child should be at home. All cultures 
made by the school inspectors, accompanied by the "cult- 
ure blanks," properly filled out and signed, should be 
promptly forwarded to the nearest culture station. 

Children excluded on account of whooping-cough, 
mumps, contagious eye diseases, parasitic diseases, etc., 
should be told to return when cured, and should be again 
examined before returning to their classrooms; if not 
entirely well they should be again excluded. 

The inspectors are required to ascertain from principals 
and teachers the names and addresses of all children from 
homes where there are contagious diseases, if notification 
has not been sent to the schools by the Board of Health ; 
and such lists are forwarded with the daily reports. In- 
spectors keep daily records in blank-books, furnished for 
such purpose, of the number of children examined (male, 
female, and total), the full names, ages, residences, and 
causes for exclusion of those excluded from school, and 
a list of cultures taken and forwarded. 

If, by reason of illness or other cause, an inspector is 



ii6 The Hygiene of 

unable to report at a school, arrangements must be made 
with an inspector of another school to act as a substitute, 
and the chief inspector informed of the facts without un- 
necessary delay. 

If, in the opinion of an inspector, immediate action 
should be taken by the Board of Health in any case, he 
immediately communicates by telephone with the chief 
inspector. Medical school inspectors report at the central 
office once during each month. Exclusion cards for pu- 
pils, daily report blanks, addressed envelopes, blank-books 
for recording the work performed, wooden tongue de- 
pressors, culture outfits, and lists of culture stations, are 
furnished at the office of the chief inspector. 

The daily duties of medical school inspectors cease 
when they have mailed their reports, after leaving their 
schools. They are not, under any circumstances, to visit 
children at their homes, to prescribe for them, or suggest 
treatment at the schools. The treatment must be received 
from the family physicians, in the dispensaries, or in the 
hospitals." 

There should be no opposition from the parents, on 
the ground of interference with the child's liberty ; on the 



Note. After the necessary disinfection and fumigation of the rooms in which there 
has been an infectious or contagious disease, postal cards are mailed by the Division of 
Contagious Diseases, notifying the proper schools that it is safe to readmit the child or 
children living in those rooms. 



the Schoolroom. 1 1 7 

contrary they should be pleased to know that their child 
is daily under a trained eye of a person who can more 
readily detect the onset of disease than they can, and 
whose only duty is to separate the infected child from his 
fellows, both for his own good and the good of the whole. 
Then, too, it must not be forgotten that disease will be 
earlier detected in its course and treatment begun at a 
more opportune time and with far better results. 

Under a perfect system the inspector will have mani- 
fold responsibilities. His duties will embrace regular 
examination of the eyes and ears. In this particular 
alone he will forestall measureless sufferings and thanks 
to him these organs will be preserved for a more useful 
future. By this same system of inspection he will avert 
many cases of spinal distortion and stooped shoulders, by 
seeing that each pupil is assigned a seat and a desk that 
is fitted to him and comfortable to use. Everything in 
the building that relates to its hygiene should be under 
his watchful eye. The heating, the temperature, the 
ventilation, the disinfection, and the sanitary closets 
would then be supervised by one competent to know the 
exact requirements of all these departments. 

The school authorities outside the principal cities of our 
country have been slow to make use of the great ad- 
vantages of medical inspection. It is not a fad, — it is an 



ii8 The Hygiene of 

ideal application of the ''ounce of prevention." No 
school is too large for its scope and none too small to dis- 
pense with it. It is a safe prediction that another decade 
will find the practice general. Delay, therefore, in in- 
stituting the regular inspection of the schools is not wise ; 
it is better to be a leader in a good movement than to be 
dragged into it later from fear of the shame of standing 
opposed to public good. 



the Schoolroom. ng 



CHAPTER XII 
Modern Education and Health 

If one were to take note of the physical condition of 
children entering school, and again of the same children 
graduating from the high school, it would be found that 
many had suffered physical deterioration by this edu- 
cating process. 

The brain has been improved and developed and the 
body allowed to care for itself. If the school work lags 
behind, if the brain works badly, there are the teacher, 
the principal, and the superintendent to be consulted about 
it — yes, even the parent receives notification that the 
child's work is not up to the standard. If the bodily 
strength is not up to par, who cares? If the cheeks of 
the little one fade day by day, and the shoulders become 
more stooped and the chest more hollowed, who is noti- 
fied? Again, the child may keep the school work up to 
the standard, perhaps be the star pupil, and yet be poorly 
nourished, pale, sickly and undersized. No one regulates 
the amount of work she is to do; her brain is stuffed 
while the remaining organs of the body are starving. 



I20 The Hygiene of 

Spurred on by teacher and parent, who see no limit to 
human endurance, the infant prodigy is developed and 
finally goes the way of all infant prodigies. 

Every physiclaii knows that his family practice annually 
brings cases worn down by school work. The major 
share of the cases are found among the girls, who usually 
are more serious students than the boys, and do not enjoy 
the invigorating exercises of the latter. 

Dr. Weir Mitchell, than whom there is none better 
qualified to speak on this subject, says : "I believe that, 
as concerns the future of our women, they would do far 
better if they were more lightly taxed, and the school 
hours but three or four a day until they reached the age 
of seventeen. Anything, indeed, would be better than the 
loss of health, and if it is a question of doubt, the school, 
unhesitatingly, shouM be abandoned or its hours greatly 
lessened, as it is at least in part the source of very many of 
the nervous maladies with which our women are 
troubled. 

''Overwork of the brain is a serious evil to women at the 
age of womanly development, when the nervous system is 
so sensitive and irritable, and at no other time is an 
abundant supply of fresh air and exercise so important. 
The American woman to-day is perhaps, of all civilized 
females, the least qualified to undertake the weighty tasks 



the Schoolroom. 121 

which tax the nervous system of women. How few 
mothers are there to-day, in the higher educated class of 
women, who have rushed through college and played the 
devotee to fashion and society that can nurse their off- 
spring !" 

Dr. W. W. Potter, in his address as President of the 
Medical Society of the State of New York, said: "The 
years between ten and fourteen are full of import for a 
girl : during them she lays the foundation for future 
weal or woe, and I hesitate not to declare that this is a 
period of infinite responsibility for mothers, perhaps the 
greatest of any part of the educational lif^ of their girls. 
Many girls begin their new physiological life at the age 
of twelve ; but, if they should not do so quite as early, this 
is still a period when nature is making preparations for a 
new existence for the young female, and if her plans are 
interfered with or thwarted, even in their smallest details, 
years — long, sorrowing years, perhaps — of pain and suf- 
fering and woe are sacrificed to the shrine of ignorance 
or wilful neglect. The scholastic training of girls is 
being carried on with its greatest vigor at the very time 
when they are physically least suited to bear the strain. 
Just when the ovary is beginning to require a large ex- 
penditure of nerve force, the brain, under our present 
system, is demanding all that an active cerebration can 
produce, and oftentimes even more. 



122 The Hygiene of 

"I am heartily in favor of the higher education of 
women, but am thoroughly opposed to the present system 
of female education. Too much is attempted in the time 
allowed in preparatory schools. It were far better to 
have fewer studies thoroughly comprehended, than to 
attempt to cram with a number that can only be super- 
ficially acquired in the time allotted to them. Notice 
some of the star pupils who have been 'prepared' for 
exhibition. That girl is a 'bright' scholar. She is a 
chronological almanac, and can tell every date in English 
history from Caesar's Invasion, or tell of all the battles 
the world has known and the number of the fallen; will 
tell you in an instant if one pipe empties a pond in seven 
hours and another in four, just how long it will take 
two to do it. She will lead you at a lively pace through 
the labyrinth of compound restrictive clauses with parrot- 
like precision, but it is simply mental discipline; a simple, 
real, face-to-face problem will cause her to falter and 
stumble." 

The present generation, taking heed to the hundreds of 
physicians who have decried present educational methods 
and their physical results, is just beginning to show faint 
signs of improvement. But even yet there are too manv 
schools, both private and public, conducted along the 
same line as Dr. Blimber's school, described by Dickens in 
Domhey and Son. 



the Schoolroom. 123 

"Dr. Blimber's establishment was a great hothouse in 
which there was a forcing apparatus constantly at work. 
Mental green peas were produced at Christmas, and intel- 
lectual asparagus all the year round. Nature was of no 
consequence at all ; no matter what a young gentleman 
was intended to bear, Dr. Blimber made him bear to order 
somehow or other. This was very pleasant and ingenious, 
but the system of forcing was attended with its usual 
disadvantages ; there was not a right taste about the pre- 
mature productions, and they didn't keep well. . . . 
And people did say that the doctor had rather overdone it 
with young Toots, who, when he had whiskers, left oflf 
having brains." 

Savage nations have always held education in small 
favor, finding by experience that the school acted badly on 
the bodily health of their children. Dr. J. H. Kellogg, 
of Battle Creek, Michigan, cites an example of personal 
observation that emphasizes well this point : 

"Some years ago, while spending a short time among 
the Yuma Indians, in the vicinity of old Fort Yuma, Ari- 
zona, I observed one morning a considerable number of old 
warriors and chiefs gathering in from the forest and col- 
lecting in the old fort. Upon inquiring I found there was 
to be an Indian school-meeting, the first one ever held 
Among the Yumas. 



124 The Hygiene of 

"The school had been started some two years before by 
Sister Alphonse and two or three other devoted CathoUc 
sisters, who had ventured into the wilds of Arizona to 
undertake the experiment of educating the Yuma boys 
and girls ; but their school had not prospered. The chil- 
dren had been kindly treated ; they had been supplied with 
an abundance of food, whereas before they were often 
hungry ; they had been furnished with clothing, including 
hats, bonnets, shoes and stockings, whereas before they 
had roamed the forest in nakedness. The schools were- 
furnished with all the necessary modern appliances and 
the teachers labored earnestly in behalf of the students. 

"Nevertheless, Sister Alphonse confessed to me that the 
school was not a success, and that the old Indians were 
very much opposed to it. I inquired the reason for their 
opposition, and was told that the Indians complained that 
going to school did not agree with the health of their 
children; that after having been in school a few months 
they were far less robust and vigorous than before, and 
that they suffered from indigestion, catarrh, and other 
diseases, from which they were before as free as the 
birds, the antelopes, and the prairie dogs among which 
they lived. The good sisters honestly admitted that the 
complaint of the old Indians was not without foundation 
and that it was true that for some reason the little wild 



the Schoolroom. 125 

children of the forest began to lose their vigor and 
vivacity soon after entering school, and therefore some of 
the most sagacious parents had kept their chidren at 
home. 

"The school meeting had been called for the purpose 
of presenting to the old Indians the advantages of an 
education, so as to convince them, if possible, that the 
children would better have an education even if the get- 
ting of it should spoil their stomachs, weaken their lungs, 
destroy their keen sense of smell through catarrh, impair 
their eyesight, dull their hearing, and deprive them of the 
hardihood which had enabled them for centuries to main- 
tain the independence which they still possessed. 

'T did not remain to hear the conclusion of the matter, 
but a few years later, in passing through the country on 
a visit to the Pacific Coast, I spent a day among 
the same Indians. I found the school flourishing, to 
the great delight of the good sisters, but the children 
perishing. Their forest air of rollicking freedom had dis- 
appeared, and the evidences of physical depression and 
deterioration were unmistakably apparent. Civilization 
had conquered, and the Indians had become convinced 
that their children must be educated even at the expense 
of health and vigor." 

With such undeniable proof of the unhealthy drift of 



126 The Hygiene of 

modern school methods, we should study to find the causes 
and remedies of the effects produced. 

School children are prone to suffer from anaemia, in- 
digestion, headache and neuralgia, insomnia, nervousness, 
chorea, and fatigue. Anaemia is a condition visible as 
a great pallor of the skin and weakness. It is the com- 
mon complaint when a child is spoken of as being "run 
down." It is often persistent in its course, appearing 
most often in girls, and sometimes is the herald of a life- 
time of weakness and invalidism. Lack of exercise, too 
much confinement, and improper nourishment, are the 
commonest causes. Indigestion sometimes appears alone 
or accompanied by anaemia, and has usually the same 
causes. Headache and neuralgia claim many sufferers 
of school age, and are attributable to poorly ventilated 
rooms, over-study, eye-strain, and fatigue. Insomnia is 
most often noted among school children who worry es- 
pecially over keeping up the work, or about examination 
time, when the brain becomes over-taxed. 

Chorea, or St. Vitus Dance, is common in school life. 
It consists of irregular, involuntary contraction of mus- 
cles, sometimes with slight mental disturbances. At 
times the muscles of the face or neck, or the head itself, 
may twitch, producing horrible grimaces. It may be 
hereditary or be the result of exhaustive drains on the 



the Schoolroom. 127 

nervous system from school work. Immediately when 
recognized the child should be removed from school, both 
for his own sake, for the quiet it secures, and the good 
of the remaining pupils, for careful observers have traced 
cases that were caused by children's' imitating the move- 
ments of a real sufferer. It lasts in mild cases about 
ten weeks, but some cases may last six months or more. 
The child should not be returned until after a physician 
has pronounced the disease entirely cured, as in numerous 
cases too early return to school was followed by relapse. 
When hysteria is encountered at school the victim should 
be placed in a quiet room and left absolutely alone. Sym- 
pathy or attention from those around serves only to in- 
tensify the attacks. 

Nervousness, the American national disease, is a hyper- 
excitability of the nerves, which shows itself in various 
forms. The most prominent symptoms are twitching of 
muscles, convulsive movements, drowsiness, headache, ir- 
ritability, great restlessness, unexplainable fears, inde- 
cision, and inability to concentrate thought for any great 
period of time. In many cases it is hereditary, and in 
other cases acquired. If it be true that nervousness and 
its grown-up brother, nervous prostration, are so typically 
American, it would be national wisdom to find out how far 
they are caused by school work, and to attempt to cut them 



128 The Hygiene of 

off ere they have driven their roots into the very ground- 
work of the child's constitution. To begin with, chil- 
dren are sent to school too young for serious study. The 
kindergarten should receive children from four to seven 
years old. At seven years of age, at least no earlier than 
six, the real primary work may commence with the 
normal child. But if a child be backward in development, 
either mental or physical, his entrance into school should 
still be delayed. 

With children from six to ten years of age there should 
be two sessions of no greater length than an hour and a 
half each; from ten to fourteen, two sessions of one and 
three-quarters hours each ; and for the remainder in public 
schools two sessions of two hours each. 

All medical men who have studied the school question 
hygienically have pronounced the school hours too long, 
and have proved that just as good results can be got 
from the plan of reduced hours as from the plan in prac- 
tice to-day — even better intellectual and indubitably better 
physical results. 

"Mr. Charles Paget, formerly M. P. for Nottingham, 
England, once tried in the village school on his estate 
at Ruddington a very interesting experiment. He was 
not satisfied with the general progress made by the boys, 
and he provided for them a large garden. The school 



the Schoolroom. 129 

was then divided into two similar sections, one of which 
was kept to the ordinary school work for the ordinary 
hours, the other for half of these hours only, the rest 
of the school time being devoted to work in the garden. 
At the end of the term the half-time, or gardening, boys 
had excelled the others in every respect ; in conduct, in 
diligence, and in the results of study." 

This illustration is not overdrawn, nor at all hard to 
explain. A similar experiment was tried in this country 
in a school in which the girls excelled the boys at first. 
The boys were set free to play during one-half the former 
school hours. The result was that the bo;j^s soon over- 
took and excelled the girls. 

If, then, better work is obtainable in half the time, 
where is the wisdom of such long hours ? But, the answer 
comes, we have the schools and the teachers at our service, 
and in many cases the mother is glad for the time being 
to have the child cared for and her own burdens made 
lighter. All true enough, but too little reason for the 
child's confinement when health is in danger. 

In communities where great crowding is the rule, and 
schools are opened in basements and every other available 
space, it would be far wiser to have relays of pupils in 
the regular school buildings. For instance, just as good 
results would be accomplished by having the first division 



130 The Hygiene of 

come to school at 9 a. m., remaiix until 10.30 a. m., and be 
dismissed. At the latter hour school would then begin 
for the second division and continue until 12 m. At 
1.30 p. M.^ the first division would reassemble and work 
until 3 p. M., when the last session of the second division 
would begin, lasting until 4 p. m. In this manner double 
the ordinary number could be housed and under better 
conditions than temporary quarters could provide. 

The assignment of work to pupils, it is hoped, will some 
day be radically changed. As a measure of economy, the 
ordinary school is now divided into two or more classes. 
The pupils of each class, without regard to their capacity, 
are supposed to keep up with the work of their fellow 
pupils. It is true that the allotment of special work to 
each individual child would multiply the work of the 
teacher; yet this plan deserves serious consideration. In 
industrial life it has always proved impossible for a num- 
ber of men to accomplish equal amounts of ''piece work" 
unless the required amount is a very low one, so low as 
to be far below the ability of a great many. The same is 
true in school work. If an amount of work is allotted 
sufficient for the dull ones, it will be a too easy task for 
the brighter ones. The standard of work is therefore 
set high, and many are dragged along, doing more than 
their brain power should allow, and actually suffering 
from the study imposed. Ideal conditions will only be 



the Schoolroom. 131 

found when the right measure of a child's capacity can 
be found and the required work can be made com- 
mensurate with it. 

In America to-day all roads leads to specialization : the 
old-time general education, which was a conglomerate 
cramming, an educational potpourri, is fast giving away 
to specialties. The high schools and the colleges all have 
courses leading to definite departments of life without 
taking on the many useless frills. So, also, the work in 
the lower schools should be shorn of all that is useless. 
It is better that proficiency be attained in a few studies 
than to have a smattering of all. % 

Home study should be recommended only when abso- 
lutely necessary, and if the child's physique is below par, 
not at all. For children below the age of twelve, the 
hours at school, if used to the best purpose, take all of the 
time in which the brain should be used, and the additional 
home work, which is most often done at night, and by 
artificial light, destroys much of the bodily energy which 
could be used more advantageously. The same is true of 
the "extras," such as music, painting, and needlework. 
Many a growing girl is unable to stand the double strain 
of arduous school duties followed by hours of practice in 
accomplishments forced upon her by proud parents. The 
parent is the true arbiter of the question, and if the ''ac- 
complishments" must be had, the time allotted for them 



132 The Hygiene of 

should not be so great as to interfere with the regular 
school work. Dr. Halle of Berlin states that out of every 
one thousand young girls who begin to learn the piano 
before they are fourteen, six hundred are affected by 
some kind of nervous disease, while out of one thousand 
other girls who are not taught the piano only one hun- 
dred suffer in a like manner. The doctor recommends 
that the study of the piano should not begin until after 
the age of sixteen. 

It is not proper treatment to keep a dull child after 
school for inefficiency. He may be one who has tried 
hard and is unable to come up to the standard. To keep 
him after school will surely make him duller. The 
school course should be a flexible one, and no tasks 
should be given to any pupil which he cannot accomplish 
during ordinary school hours. 

Many pupils are able to keep up with their classes by 
dint of hard work, but find when examination time comes 
that the extra labor incident to review is too great. Then 
they succumb. More pupils suffer from headache, 
fatigue, and nervousness, at the time of, and after exam- 
ination, than at any other period of the school year. For 
this reason many are now wisely pleading for the abolition 
of competitive examination as being useless and as expos- 
ing the pupil to physical harm. This reform could be 
carried through without loss to school work. 



the Schoolroom. i-^^ 

All of the many enumerated causes, either singly or 
combined, lower the force of the nervous and muscular 
system: the brain power is at a low ebb and physical 
strength also suffers. This is the state spoken of as 
fatigue. In this condition the child has not one-tenth 
of his normal power, his ability to concentrate is poor, 
and his retention is almost nil. In such cases a period of 
long rest from the school is advised. With milder cases, a 
lessening of the work, with opportunities for physical 
building up, will suffice. 

The lessons should be short and there should be pauses 
between long ones. Best attention in sch(^l can be had 
during the opening hour of the morning, as the child's 
mind is then in best condition for work. Too often this 
valuable hour, which should be devoted to the most diffi- 
cult studies, is given to miscellaneous exercises, interest- 
ing, it is true, but better adapted to a later hour in the 
morning, when fatigue has already made itself apparent. 
The best hours for school work are from 8 to 10.15 
A. M.; the worst hour is from 11 to 12. From i to 2.30 
p. M. is the third best, and from 3 to 4 the second best. 
Kemsies says the studies he found to be most fatiguing in 
order were : gymnastics, mathematics, foreign languages, 
religion, mother tongue, natural history, geography, his- 
tory, singing, and drawing. In Paris, at the Lycee, the 
Minister of Education allowed a teacher to change the 



/34 The Hygiene of 

order of the work to accord more with his idea O'f the 
pupil's ability, and found that the work that usually re- 
quired seven years was as well done in three and o-ne- 
half. Lastly, the greatest enemy to fatigue was the old- 
fashioned recess, where the children were allowed ten or 
fifteen minutes of play. Teachers complained that this 
recess got the pupil's mind off the work. This is the 
simplest and best argument in its favor. 

In order to present a clear mind for school work in the 
morning, it is very essential that a child have the requisite 
amount of sleep for one of his age. 

The average amount of sleep required at 
4 years old is 12 hours. 



7 


a 


a 




II 


9 


{( 


a 




ioy2 


12-14 


li 


i( 




9-10 


14-21 


{( 


it 




9 



It will be difficult to attain to the ideal at once, but ad- 
herence to these suggestions will go a long way towards 
giving better bodies to our school children, probably with 
no loss to the mental faculties. It is useless to store a 
beautiful mind in an unhealthy body. The real education 
is a healthy combination of good mind and good body, 
for, as Paley says, 'Tt is every preparation that is made 
in our youth for the sequel of our lives." 



the Schoolroom. 135 



CHAPTER XIII 
School Diet 

The subject matter of the present chapter has greater 
interest for boarding schools than for public schools. In 
the latter, however, it should be a subject for investigation 
by the teacher, that she may be able to instruct the pupils 
as to what foods and what quantities are most suitable 
during school life, when physical and mental growth are 
most exacting in their demands. 

Parents, ordinarily, manifest little concern in the diet 
of the child, offering the same foods to one of tender age 
as are offered to the robust workingman. The excuse in 
many cases is that with moderate means it is well-nigh 
impossible to present a great variety, and economy forces 
all the members of the family to partake of the same 
eatables. Fortunately, this is false reasoning, for it is 
the truth that the most nutritious foods are those of least 
cost. Advocates of particular dietary fads, such as ex- 
clusively vegetable food, are not to be heeded, for experi- 
ence has taught that with the school child a wise variety 
combining proper admixture of animal, vegetable and 



136 The Hygiene of 

cereal food is what is desired. Many parents of means 
are ignorant of these matters, and short talks by the 
teacher to the pupil will be productive of great good. 

Many diseases are traceable to faulty diet. The system 
becomes debilitated because the food taken does not 
supply vital power enough to blood, bone and muscle. 
Disease setting in with such patients finds especially easy 
prey. Of one thousand pupils examined surely forty 
per cent, were really ill-nourished. Their pale, drawn 
faces and thin bodies told the tale, and carrying the in- 
vestigation still further into the homes, many times it 
was found that the child was a voracious eater, but always 
fondest of just such foods as did not add to his mind or 
his muscle. 

Children should rise from bed in the morning in suffi- 
cient time to eat their meals slowly, and not have to 
bolt a hasty breakfast. The habit of deliberate eating 
should be cultivated in youth. Food taken into the 
mouth in large portions and only partially mixed with the 
saliva gives the stomach three times the ordinary work. 
Soon this organ rebels and will be unable to digest food 
even if properly taken. Breakfast and supper should each 
consume at least one half-hour's time, and the dinner 
three-quarters of an hour. 

Young children from seven to fifteen years of age may 



the Schoolroom. 137 

find it too long a time to wait for food during the long 
sessions of the school. In such cases the parents should 
send a lunch to be eaten at a definite hour rather than 
sweets or fruit that will be nibbled at from time to time. 

Strange as it may appear, breakfast is the meal most 
difficult to provide for the scholar. Often the anxious 
parent brings the child to the physician with the story that 
it is impossible even to force the child to eat upon rising 
from bed, and that day after day he goes to school with 
an empty stomach. Long before noon the child is weak 
and has a violent headache. Often this loss of morning 
appetite is due to sleeping in a poorly ventilated room, 
or, perhaps, to too late hours. The best remedy lies in 
providing plenty of fresh air in the sleeping room and 
in sending the child to bed in time to get sufficient sleep 
by early morning, when an hour can be taken for a walk 
or some exercise before breakfast. 

The breakfast meal should consist of eggs, cereals, fish, 
bread and butter, fruit, milk or cocoa. If the tea or 
coffee habit is already formed, the drink should be served 
very weak, principally hot water or milk. But it is better 
for children to avoid tea and coffee altogether, as there is 
no good derived from them, and their injudicious use 
often leads to such ailments as nervousness, indigestion, 
and constipation. It were better if meat were not 



138 The Hygiene of 

served for the morning meal. The dinner should be at 
mid-day, and should comprise soups, meat, potatoes, and 
other vegetables, with some pudding, pastry, and fruit. 
The best meats for children are roast beef, beef steak, 
roast lamb, mutton, chicken, and bacon. Pork and veal 
are not suitable. Supper, to ensure a good night's sleep, 
shoiuld be an easily digested meal. Porridge or rice, with 
miilk or cream, bread and butter with preserves, some light 
pastry and hot milk, with but small portions of meat and 
vegetables, are most serviceable. Many refuse to give 
meat and vegetables for this meal, but they may be eaten 
without harm by those over twelve years of age. 

Alcohol should not be given in any form to children. 
Setting aside the moral question, from a physical stand- 
point the use of alcohol works only harm upon the child. 
It retards growth and induces nervousness and irritability. 
These words are intended as a warning to those among 
the poorer classes who serve beer to their children with the 
idea that it is good for them and will help their appetite. 
If the beverage is not offered to children they do not 
desire it. Milk is cheaper and is incomparably better 
for themi. There can be no excuse, then, for the use of 
alcohol, unless prescribed by a physician. In some of the 
debilitating diseases, in children suffering from anaemia 
and inherited consumption, it is sometimes prescribed in 



the Schoolroom. 139 

the form of a light wine, but its use should always be 
guarded. Milk is nature's ideal food, and a child's home 
education is neglected if he is not taught to drink it with 
pleasure. It should form a large part of the child's diet, 
be given at each meal, and even at night should a child 
wake up hungry. To persons who are charitably inclined 
and ever ready to help the poor, we suggest that it would 
be an excellent idea to establish a fund for supplying a 
daily lunch of milk and crackers to the children in some 
of the schools whose ranks are filled mostly from the 
poorer people. A glance into these schools shows num- 
bers of poorly nourished little ones who would be greatly 
benefited by a light lunch in the middle of the morning 
and afternoon session. 

Fruit makes healthy food for the young, and they 
should be given a bountiful share of it with their meals. 
Sweets, meaning thereby candies, would serve a good 
purpose in supplying a needed part of the sugar to the 
system, were it not a fact that so much is ordinarily taken 
as to destroy the appetite for the usual meals. Confec- 
tionery should never be a part of the school lunch : the 
same applies to pickles, a favorite relish which satisfies 
in some a craving for something bitter, but is of no use 
as a food. 



I40 The Hygiene of 

For school diet, then, nutritious foods are to be used, 
the meals should be regular, the articles of food thor- 
oughly masticated and slowly swallowed. The child 
should be taught to eat those articles known to be nu- 
tritious, even though he dislikes them at first. With a 
little patience, in the same manner that he can be taught 
to overcome any other repugnance, a child can be taught 
to eat and enjoy the foods known to be best for his par- 
ticular period of growth. 



the Schoolroom. 141 



CHAPTER XIV 
Physical Training and Exercise 

It is important that the school in exacting from the 
pupil five hours of daily concentration upon study should 
plan periods during the day when the mind can be rested 
and when pleasing, helpful exercises of the body be sub- 
stituted for mental drill This relaxation can be sought 
in any form of physical exercise desired, whether in reg- 
ular studied calisthenics or in unrestrained play. Phy- 
sical training will give the same power and control to the 
muscles that mental training will give to the mind. 

Calisthenics should be as compulsory as any other work 
miless a child presents a certificate from a physician to 
the effect that the particular child has something in his 
physical make-up which forbids this work; but because 
a child is weak and delicate is no reason why the gym- 
nastic work should be entirely prohibited. Such cases 
demand intelligent treatment, and necessitate a lessening 
in the period of time spent rather than an entire abandon- 
ment. It is important, then, that some study should be 
given to the question of the exercise most suitable to age 



142 The Hygiene of 

and sex, the proper time, and the amount of time to be 
consumed. 

The calisthenics are best given during the first period 
of school work and should not take over fifteen minutes. 
Bv investio^atins; it has been found that the exercises as 
carried out under the instruction of a physical director 
are very fatiguing if kept up longer than fifteen minutes. 
The principal reason for this is that the work is too se- 
rious and studied and the child takes it as a task rather 
than a recreation. Some very careful and observing ed- 
ucators have of late years recommended for the lower 
grades short periods of play at intervals during the school 
hours, with real games, which please and spur the child 
on, giving the desired relaxation from mental work. 

The particular exercises given to the young are treated 
in books devoted to this special subject, but in general it 
is proper to insist that much of the work should tend to 
make the child stand erect, walk properly, and breathe 
well. Respiratory gymnastics can be taught in the school 
and the practice taken at any time; the training should 
teach that proper respiration consists not in quick, sud- 
den gasps but in taking deliberate long breaths that give 
extensive expansion to the chest. So important is the 
breathing capacity considered that all insurance com- 
panies in their medical examinations ask to know the 



the Schoolroom. 143 

amount the chest expands from a deep exhalation to a 
deep inhalation. Further, it is a well known fact that 
people wdio continually breathe through the nose are less 
liable to infectious diseases and pulmonary complaints, 
and that those who sleep with the mouth closed never 
awake with the painful and disagreeable sensation of 
parched throat and cracked lips. It is impossible, how- 
ever, in such a work as this to go over all the different 
exercises practised in physical training. These few 
points about respiratory gymnastics are mentioned only 
to call attention to the importance of the subject. Cer- 
tain occupations, certain games, tend to develop certain 
sets of muscles ; physical training benefits all muscles. 

As a matter of economy, in a number of communities 
attempts have been made to have this line of work done 
by the regular teacher, who in turn was supposed to have 
received some training in the methods of physical exer- 
cise. This plan has always proved to be .unwise; the 
work is never carried out as well or with such interest 
as when directed by a physical instructor. 

Athletics in some form or other can be commenced 
about the twelfth year. If in the school gymnasium, they 
should be under the trained eye of some qualified person, 
as there is great danger of young children's over-exert- 
in2- themselves in trying to do the same feats as their fel- 



144 The Hygiene of 

lows. In the gymnasium two half-hour periods, one in 
each session/ are sufficient. Dr. Sargent urges that no 
violent exercise be taken until three hours after a meal. 

The outdoor play is not so easily regulated as the in- 
door, but the pupils should be taught that no exercise 
is beneficial which is carried beyond the point of bodily 
fatigue. Horseback riding and bicycle riding are invigo- 
rating and healthful exercises. The wheel, however, 
should be used in moderation. The mooted question as to 
whether wheeling is a healthy exercise for girls is gener- 
ally settled in its favor, if only the girls use some discre- 
tion and avoid long, violent rides and riding at the men- 
strual period. The chief trouble with boys who ride a 
wheel, is in getting them to ride in an upright position, 
their desire to be racers inducing them to assume a 
stooped position which is anything but beneficial. The 
principal exercises suitable for girls are golf, lawn tennis, 
swimming, fencing, and basket-ball. All are sufficiently 
exhilarating to be enjoyed and do not require the great 
endurance that some of the m-ore rugged sports do. 
Baseball, football, rowing, boxing, wrestling, bowling, 
swimming, and running are the exercises that best please 
the boys. All should be learned and practised. Some 
have a good influence on one set of muscles, while others 
help the lungs, heart, and stomach. 



the Schoolroom. 14^ 

Every teacher should interest himself or herself in out- 
door sports and remember that the ideal pupil is the one 
that leaves the school with a strong mind to battle with 
the world and a strong body to carry that mind about in. 
There are too many children who are encouraged to 
spend their spare time at school and at home always with 
books that they may excel in their studies, and yet who 
are easily distanced later in the real school of li:^e by their 
less intellectual but more sturdy fellows. 



146 The Hygiene of 



CHAPTER XV 
Corporal Punishment 

It is but a few years since the practice of corporal pun- 
ishment was very general. Severe punishments and flog- 
gings were often resorted to, even to such an exient as to 
physically disable the pupil for a few days at the time. 
Schools in certain districts engaged their teachers upon 
muscular qualifications rather than mental. Thrashing 
was thought to be an essential to education, and if a pupil 
did not or would not learn the lessons, he had them 
"knocked into him." It is pleasing to note, however, 
that with the great improvement in all educational mat- 
ters this practice has almost entirely disappearel. To- 
day better discipline is maintained in just such schools by 
young school-ma'ams who never wield the birch but have 
been carefully trained in properly handling school child- 
ren. To-day the best teachers are those who find least 
need to resort to corporal punishment. 

But there still goes on a discussion as to the necessity 
at any time of corporal punishment, by which we mean 
some pain or suffering inflicted upon the body of the pu- 



the Schoolroom, i^y 

pil for some offence against the school law. Many who 
have gladly seen its use lessened to a minimum contend 
very strongly that there still is a use for guarded corporal 
punishment in the schoolroom and that there are cases 
which cannot be successfully treated by other means. 
And there are undoubtedly some few, the bullies usually, 
who sneer at moral suasion and any corrections other 
than corporal punishment. 

On the other hand there are those who insist upon the 
entire abolition of corporal punishment in schools, hold- 
ing that it is never of any use as a corrective measure; 
that wherever allowed, it is abused; and thaf it is an end- 
less source of trouble between teacher and parent. It is 
probable that the truth lies half-way between,-^that In 
the great majority of cases other means should be re- 
sorted to, but that doubtless there are cases where, with- 
out the use of corporal punishment, no impression what- 
soever can be made. 

Rollin, the French historian so well known from his 
Ancient History, early in the i8th century wrote a "Treat- 
ise on Studies," in which he has well-defined views on the 
subject under consideration. The following are a few 
extracts : 

"I. The first duty of the teacher is to study well the 
p-enius and character of children. To wish to place them 



148 The Hygiene of 

on the same level, and to subject them to a single rule, 
is to force nature. 

"2. In education the highest skill consists in knowing 
how to unite, by a wise temperament, a force that re- 
strains children without repelling them, and a gentleness 
that wins without enervating them. 

"3. The short and common m-ethod of correcting 
children is with the rod; but this remedy sometimes be- 
comes a more dangerous evil than those which one seeks 
to cure, if it is employed without reason and moderation. 

''4. The only vice, it seems to me, that deserves se- 
vere treatment is obstinacy in evil, but an obstinacy vol- 
untary, determined, and well defined. 

''5. The teacher ought never to punish in anger, 
especially if the fault which he punishes concerns him 
personally, such as a want of respect or some offensive 
speech. 

"6. Cuffs, blows, and other like treatment, are abso- 
lutely forbidden to teachers. They ought to punish only 
to correct, and passion does not correct. 

"7. It is a quite common fault to make use of repri- 
mands for the slightest faults which are almost mevitable 
to children. This breaks the force of reprimands and 
renders them fruitless. 



the Schoolroom. i^g 

"8. We should avoid exciting the spite of children by 
the harshness of our language, their anger by exaggera- 
tion, their pride by marks of contempt. 

"g. It is necessary always to show children a substan- 
tial and agreeable end which may hold them to work, and 
never pretend to force them by a direct and absolute au- 
thority. 

''lo. We should run the risk of discouraging child- 
ren if we never praised them when they do well. Al- 
though praises are to be feared because of vanity, it is 
necessary to make use of them to encourage children, 
without cultivating that vice. ^ 

"ii. Rewards are not to be neglected for children, 
and although they are not, any more than praise, the 
principal motive to make them act, yet both may become 
useful to virtue, and a strong incentive to its practice." 

Horace Mann, in his "Lectures on Education," in re- 
ference to this subject says: "Yet great as the evil is, 
I admit that it is less than the evil of insubordination or 
disobedience. It is better, therefore, to tolerate punish- 
ment, in cases where the teacher has no other resource, 
than to suffer insubordination or disobedience in our 
schools. Yet how infinitely better to secure order and 
proficiency by the power of conscience and the love of 
knowledge — ^to supersede the necessity of violence by 



150 The Hygiene of 

moral means. This is already done in a considerable 
number of schools ; I trust it is done, with regard to some 
scholars, in every school ; that is, I trust there are at least 
some scholars, in every school in the Commonwealth, who 
never know the degradation of the lash. I trust there is 
no teacher with such a vacuum of good qualities and 
such a plenum of bad ones, as to create the necessity for 
indiscriminate and universal flogging. What, then, ought 
teachers to do? I answer, they should aim to reach 
those higher and higher points of qualification, which 
shall enable them to dispense more and more with 
the necessity of punishment. If there is any teacher 
so low in the scale of fitness or competency as to feel 
obliged to punish every day, he should strive to prolong 
the interval to once a week. If any teacher punishes but 
once a quarter, he should strive to punish but once a 
year." 

Editorially speaking on this subject, the New York 
Medical Record says, "The question of corporal punish- 
ment in schools has been much discussed lately in Ger- 
many and Switzerland, and the Canton Berne has come 
to a decision in the matter. The Ethical World considers 
the new law a compromise between the flagellants and the 
anti-flagellants. It prescribes the use of the cane for 
grave faults such as indicate moral perversion ; repeated 



the Schoolroom. 151 

lying is given as an instance, and it is expressly forbid- 
den to punish for want of application. Girls are not to 
be punished physically at all." 

Certain forms of punishment are never to be tolerated, 
such as pulling or boxing of the ears. Serious damage 
has time and time again been done by teachers who, in 
their haste, have inflicted punishment in this manner. 
Slaps or blows upon the head likewise cause at times 
grave discomforts which persist for some time, such as 
dizziness and headache. It is well to remember, as Dr. 
Bristowe says, that there are some parts of the body that 
seem to be made for chastisement ; and hcL speaks of the 
''posterior aspect of the human form divine." There is 
nothing so demoralizing to discipline as for a teacher to 
strike such a blow in anger and then spend the following 
hour in coddling back the same child to good nature. 
If corporal punishment is to be inflicted, it should not be 
done at the time of the offense, but later, when all traces 
of anger that might have existed shall have passed away. 

Keeping in at recess and after school is not a right 
means of punishment, as all agree that the school hours 
are sufficiently long and fatiguing. Such tasks as stand- 
ing for long periods should not be imposed on growing 
children, as long continued standing conduces to stooped 
shoulders and curvatures of the spine. Committing to 



152 The Hygiene of 

memory or writing long extracts accomplish but little in 
a corrective way. The most satisfactory means of cor- 
rection with many pupils will not be in imposing difficult 
tasks at the expense of bodily energy, but the deprivation 
of certain privileges and pleasures that are accorded their 
better-behaved fellows. 

Before punishing for want of application the teacher 
must satisfy herself of two things : first, that the task be 
not greater than the ability, and secondly, that there is 
no bodily defect which unfits the pupil for school work, 
such as defects of eyes, ears, or any abnormalities, such 
as adenoid growths in the throat. 



the Schoolroom. 153 



CHAPTER XVI 
Sickness and Accident in the Schoolroom 

In considering ideal conditions in the schoolroom that 
tend to the prevention of sickness and accident, it is but 
a step away to dwell for a moment on what is first to be 
thought of when such complications arise in school. It 
is a wise thing for a teacher to know what to do and what 
not to do, — to know her own real limitations. 

Ordinarily if "a little knowledge is a dangerous thing," 
then a little knowledge of medicine and surgery is doubly 
dangerous; but in the government of hundreds of chil- 
dren gathered under one roof and engaged at times in 
rough games, accidents are sure to occur and the teacher 
is always the first one to look to in such emergencies. 
The same applies with equal force to the minor ailments 
of children during the school hours. 

With sickness the teacher may use such natural means 
as her knowledge directs, like applications of hot or cold 
water, vigorous rubbing, recumbent posture, or removal 
to a quiet room, but she should never use medicines with 
any of the pupils. The giving of medicine is entirely be- 



154 The Hygiene of 

yond her province, and though always done with good in- 
tent may sometimes lead to unpleasant complications. 
Reference is made principally to the use of headache pills, 
powders, or capsules which are in such common use, yet 
all of which contain dangerous drugs. 

Headache may be treated by removal from the main 
room, which is often apt to be overcharged with impure 
air, and by applications to the forehead of cold water, 
and of smelling-salts to the nostrils, with dismissal if the 
pain persists over a half-hour. Remember, in constantly 
recurring headache, the role the eyes play ; often changing 
the seat to give more favorable light will be of benefit. 

With toothache and earache it is not wise to use any- 
thing but applications of hot cloths externally. If this 
means be not successful other means of relief should be 
sought outside the schoolroom. 

Fainting is a common occurrence in schools, but usually 
is of only momentary importance. A child who has 
fainted should be immediately taken from the presence of 
the other pupils and laid down with the feet several inches 
higher than the head. The clothing should be loosened 
and the face and hands bathed in cold water. Within 
five minutes there should be some signs of returning con- 
sciousness, shown by muscular movements and return 
of blood to the face. 



the Schoolroom. 155 

Fits or convulsions are less remediable, occupying a 
regular interval and being little influenced by outside 
treatment. They are usually a form of epilepsy, most 
often what is called ''petit mal," and when encountered 
at school should be treated like fainting spells. What- 
ever measures are resorted to will do little beyond serv- 
ing the useful purpose of keeping those about employed 
in doing something. With many cases of epilepsy it is 
not advisable to send the patient to school at all, as attacks 
then occur with greater frequency; but numerous cases 
are found just on the border line where the spells are in- 
frequent and mild, that do well at school!* 

When one is sunstruck or overcome with the heat it is 
advisable to secure as speedily as possible a physician's 
services. In the meantime, the patient should be removed 
to a shady spot, the clothing loosened, and applications of 
cold water and cold cloths made. 

In cases of frost-bite, which usually affects the ears, 
hands, or feet, the affected portion should be vigorously 
rubbed with snow or ice water and heat should be applied 
only very gradually. 

Attacks of hysteria, such as immoderate laughing or 
crying without cause, are difficult to handle. They require 
a firm will to combat their display and fiever should be 
given any coddling or petting. 



156 The Hygiene of 

For accidents it would be wise for a teacher to keep on 
hand such articles as a few bandages, some absorbent 
gauze and cotton, vaseline, and a solution of carbolic acid, 
one part to 100 of water. Many minor accidents could 
be looked after easily with such dressing at hand. A 
teacher should be everything at school to the child that 
the mother is at home. 

Bruises and many cuts, if they seem to be of no depth 
or importance, can be bandaged at the time of accident. 
This immediate bandaging of bruises about the head will 
give relief and prevent future swelling. 

A dog bite should at first be thoroughly cleansed and 
then the patient dispatched to a surgeon to be cauterized. 

Burns, unless of a very minor degree, should be sent 
to the surgeon after a preliminary application of vaseline 
has been made. 

Nosebleed is best overcome by the sitting posture, and 
pressure appHed to both nostrils without any effort at 
blowing. If persistent, there are a number of other 
means to be used. Raise the arms above the head, apply 
ice to the nostrils and to the back of the neck, immerse 
the lower limbs in hot water to the knees or bandage 
them. Hot water or ice may be introduced into the nos- 
trils. Should the use of these expedients not suffice more 
skillful treatment may be required. 



the Schoolroom. 157 

Hemorrhage from any bleeding vessel is best controlled 
by applying a compress of a folded towel, preferably 
soaked in hot water, to the affected part. If one of the 
larger vessels of the limbs is severed more heroic treat- 
ment is necessary. Then the first instruction is to get at 
the source. If necessary cut the clothing away and apply 
compression by means of a tourniquet, which may be 
quickly improvised by tying a handkerchief or bandage 
about the leg above the injfury, inserting a stick between 
the handkerchief and limb and twisting the stick about 
until the bleeding stops. Sometimes where the hemor- 
rhage is from a vein, the hemorrhage continues until a 
tourniquet is applied to the distal side of the wound. 

Where a limb is injured and a fracture, dislocation, or 
sprain is suspected, put the limb to rest by attaching it to 
some form of a splint and send for surgical aid. Do not 
allow the limb to be pulled or manipulated in any way, 
as it will do no good and cause great pain. 

When foreign bodies, such as bits of dirt and cinders, 
get into the eye, forbid the child to rub it. Attempt to 
wash the eye out with cold water holding the two lids 
separated with thumb and forefinger; or the sub- 
stance may be removed by drawing the upper lid down 
over the lower lid. If one is skillful enough, the upper 
lid may be rolled over a pencil and search easily made for 



158 The Hygiene of 

the offending substance, which may then be removed with 
a clean silk handkerchief. 

Foreign bodies in the ear are only to be removed by 
syringing with warm water. Sometimes flies and other 
insects crawl into the ear, causing great buzzing and dis- 
comfort. In such cases, if a lighted candle or lamp is 
held at the ear the insect will usually see the light and 
come out. When this fails a few drops of warm olive oil 
or glycerine dropped into the ear will suffice. 

Where a school is in the vicinity of a river, as is often 
the case, drowning accidents are by no means uncommon. 
Whenever a person is removed from the water in an un- 
conscious and asphyxiated state, quick action is needed. 
It is impossible to have a number of rules at the finger 
ends to use, but a careful perusal of the following method, 
known as Sylvester's method of treatment of asphyxia 
from drowning, gives general ideas which should not be 
forgotten : 

Remove from the mouth and nostrils all obstructions 
to the free passage of air to the lungs ; free the body from 
any clothing that binds the neck, chest or waist ; turn it 
over upon the face for a moment, thrusting a finger into 
the mouth and sweeping it round, to bring away any- 
thing that may have gotten in or accumulated there. 
Then lay the body flat on the back, with something a few 
inches high under the shoulders, so as to cause the neck 



the Schoolroom. 159 

to be stretched out and the chin to be carried from the 
chest. Draw the tongue well forward out of the mouth 
and let it be held by an assistant. (If there be no one 
present, a pencil or small stick may be thrust across the 
mouth on top of the tongue and behind the last teeth, to 
keep the mouth open and the tongue out of the throat.) 
Place yourself on your knees behind the head, seize both 
arms near the elbows and sweep them round horizontally, 
away from the body and over the head till they meet above 
it ; give a good, strong pull, and keep it up for a few sec- 
onds. After this, return the arms to their former posi- 
tion alongside the chest, and make strong pressure against 
the lower ribs, so as to drive the air out of the chest and 
effect an act of expiration. This need occupy but a sec- 
ond of time. 

This plan regularly carried out, will make about sixteen 
complete acts of respiration in a minute. It should be 
kept up for a long time, and not abandoned until the 
heart has ceased to beat. It should be remembered that 
cessation of the pulse at the wrists amounts to nothing 
as a sign of death ; and life is present when only a most 
acute ear can detect the sound of the heart. In a moder- 
ately thin person deep pressure with the finger-ends just 
below the lower end of the breastbone may sometimes re- 
veal pulsation in the aorta when it cannot be found any- 
where else. 



i6o The Hygiene of 

CHAPTER XVII 
The Teacher's Health 

As the teacher lives in the same atmosphere as the child 
during school hours, what is beneficial to one is equally 
so to the other ; but in many respects conditions are vastly 
different. The bad air, the poor light, and the oppressive 
heat are felt by both, but with the teacher the sense of re- 
sponsibility and the nervous strain are continuous and 
wearing. 

The advent of specialization in school work divides the 
responsibility somewhat, but to carry on the work with 
justice and satisfaction to all concerned, the teacher must 
needs be a paragon of all virtues. To begin with, more 
attention should be given, in engaging a teacher, to her 
physical nature. It is very essential that she be strong 
and of good disposition. If not strong and often ill, the 
school work suffers from the numerous changes in teach- 
ing and governing. If the teacher be nervous or irri- 
table, she will do harm to the dispositions of the children 
by keeping them continually in a state of anxiety, await- 
ing each explosive outburst of nervous force. A physical 
examination should be demanded of every applicant for 
a teacher's position. The following are important points: 

I. There should be no physical defect, such as curva- 
ture of the spine. One so affected, howsoever qualified 



the Schoolroom. i6i 

mentally, is not a desirable candidate. Her physical 
strength would naturally be below par and the effect of 
such a deformity upon young children would not be good. 

II. The heart and lungs should be normal and free 
from organic disease. This is essential for good bodily 
strength which will be needed to keep the school work 
up to the standard. A sickly teacher is a listless teacher. 

III. The eyes and ears should be examined for de- 
fectiveness. Faults in the eyes can in most cases be easily 
corrected by proper glasses, but a fault in the ears is more 
serious. If existing to any great degree it should be a 
permanent bar to an applicant's appointment. 

IV. A good speaking voice is needed in order that the 
instruction may easily be heard in all parts of the school- 
room. A high pitched, harsh voice grates unpleasantly 
on the children's nerves. 

V. There should be a general summing up of the en- 
tire system, just as the medical examiner of a life insur- 
ance company decides whether an applicant for a policy 
is a good risk. If there be lowered vitality in any re- 
spect, if the applicant would prove to be a poor risk for 
an insurance company, she will prove to be a poorer risk 
for the school board to assume. 

VI. A careful study should be made of the applicant's 
disposition, to weed out all who may be victims of the 
great American disease of ''nerves," in any degree from 



1 62 The Hygiene of 

simple nervousness and irritability to the more pro- 
nounced nervous exhaustion. 

A teacher who finds herself unable to restrain her ner- 
vousness and irritability should be conscientious enough 
to seek another occupation, as this is proof positive that 
she has not the requisite quaUfications to preside over 
children. 

The most commonly observed affections among school 
teachers are nervous diseases, dyspepsia, and anaemia. 
The continued confinement, often under unhygienic con- 
ditions, and the great drain on the nervous system are in 
a measure responsible. But the teacher, more fortunate 
than many people in other walks of life, has a considerable 
space of time at her disposal. A portion of this time, — 
at least an hour — ^should be daily spent in exercise. This 
is the great remedy for the common condition of "nerve 
tire." No medicines will so effectually wipe av/ay this 
feeling of exhaustion as a romp through fields and woods, 
a spin upon the wheel, a game of golf in the summer, or 
an hour's indoor gymnasium work in the winter. Let the 
school teacher remember that as the nervous force is in 
such constant demand it should be conserved in every 
possible manner. When symptoms of fatigue and nerve 
strain are felt, avoid the use of such medicines as nerve 
tonics, which will in the end only do harm, and seek relief 
in exercise or periods of rest. 



the Schoolroom. 163 

It is wrong, however, for the teacher to become imbued 
with the idea that hers is the most exhausting and Jife- 
destroying occupation known. Some writers of late have 
dilated upon this idea and one superintendent of schools 
goes so far as to say that five years' actual service will be 
sufficient, in the majority of cases, to ruin a teacher's 
health. But experience and statistics will not bear this 
statement out, as school teachers enjoy an especially fa- 
vorable place in the tables of expectancy of life. Though 
consumption claims the largest number of victims, even 
this disease is proportionally less frequent among teachers 
than among persons of any other occupation. Diseases 
of the nervous system rank second, and heart disease 
third, as causes of death. But even so, the Eleventh Cen- 
sus of the United States gives the death rates of male 
teachers as 9.28 per thousand, and of female teachers 4.32 
per thousand, and further says that the death rate of 
teachers is much less than the average rate for all other 
selected occupations. On the whole, then, "we must take 
the rough and the thorny as well as smooth and pleasant, 
and a portion at least of our daily duty must be hard and 
disagreeable, for the mind cannot be strong and healthy 
in perpetual sunshine only, and the most dangerous of 
all states is that of constantly recurring pleasure, ease, 
and prosperity." 



INDEX 



Accident, 154 
Accommodation, 61 
Air, fresh, 17 

expired, 17 

space, 19 
Alcohol, 125 
Anaemia, 113 
Asphyxia, 159 
Astigmatism, 61 
Audiometer, 70 

Bathing, 104 
Basement, 5 
Bell, Dr. A. M., 16-77 
Biggs, H. M., 103 
Bowditch, Dr., 44 
Breathing, mouth, 72 
Bridgeport High School, 21 
Briggs, Richard, 20 
Brown, Sequard, 18 
Burns, 157 

Cellar, 5 
Chicken pox, 91 
Chorea, 113 
Cloakrooms, 6 
Conrad, Dr., 52 
Construction, 4 
Corridors, 5 
Cups, drinking, 99 
Curtains, 50 



Dampness, i 
Diet, 122 
Diphtheria, 93 
Diseases, contagious, 82 

communicable, 83 
Disinfectants, loi 
Dombey and Son, 109 
Drying closets, 7 
Durgin, Dr. Samuel 11., 133 

Ear, 68 

Emmetropia, 61 

Entrances, 5 

Epidemics, 10 1 

Ely, Dr., 51 

Erysipelas, 98 

Examinations, 119 

Exercise, 142 

Eyesight, 49-5 1' 5^ 

Eye-ball, muscles, 59 

Eye, inflammatory diseases, 97 

Fainting, 155 
Earner's, Dr., theory, 34 
Fatigue, 1 9-1 19 
Fevers, eruptive, 86 
Fever, scarlet, 93 

typhoid, 97 

typhus, 98 
Fireplaces, open, 30 
Fire screen, 30 



1 66 



Index. 



Fits, 156 

Foot rests, 38 

Fountain, drinking, 99 

Frost bite, 156 

Fumigation, 7 

Furniture, school, 23 

stationary, 38 
adjustable, 38 

Gymnasium, 144 

Harelip, 80 
Hartwell, Dr., 77 
Headaches, 113, 155 
Heat, bodily, 105 
Health, teachers, 161 
Heating, 28 

direct system, 30 

indirect system, 30 

hot water, 30 

steam, 30 

warm air, 30 
Holmes, Oliver Wendell, 17 
Hypermetropia, 61 
Hysteria, 119, 156 

Incubation, period of, 85 
Indians, Yuma, no 
Indigestion, 113 
Insomnia, 113 
Inspection, medical, 128 
Invasion, period of, 86 

Johnson, James, Dr., 16 

Kellogg, Dr. J. H., no 
Kindergarten, 115 

Larynx, 75 
Lamb, Chas., 34 
Light, 46 

artificial, 48 



Lincoln, Dr. D. F., 37 
Lockers, 6 

MacKenzie, Morrell, Sir, 79 

Measles, 92 

Menengitis, cerebro spinal, 98 

Mitchell, Dr. S. Weir, 107 

Mowry, Dr. W. A., 49 

Mumps, 97 

Myopia, 61 

Nervousness, 114 
Neuralgia, 113 
Nose bleed, 157 

Odors, 25 

Paget, Chas., Mr., 115 
Peck, Gov., 26 
Pershing, Dr., 78 
Photometer, 49 
Playground, 3 
Potter, Dr. W. W., 108 
Prisms, 49 

Programme, school, 67 
Punishment, corporal, 147 

Recess. 25, 121 
Ringworm, 98 

Schools, private, 182 

parochial, 182 
Sunday, 182 

Scudder, Dr. Chas. L,, 38 

Sickness, 154 

Slate and pencil, 100 

Sleep, 121 

Soil, I 

Small-pox, 86 

Stairs, 6-1 1 

Stammering, 76 



Index. 



167 



Steam, 30 
Stoves, 30 
Study, home, 1 1 8 
Stuttering, 76 
Sunstroke, 156 
Sweating, insensible, 18 

Teeth, defective, 81 
Temperature, 28 
Thermometers, 28 
Tongue-tie, 80 
Tooth-ache, 155 
Towel, 100 

Training, physical, 142 
Tuberculosis, 95 
Type, 66 

test, 62 



Vaccination, 86 

Ventilation, 15 

gravity system, 20 
fan system, 20 

Ventilators, window, 23 

Vocal organs, 74 

Walford, Dr., 100 
Wardrobes, 6 
Water, 97 
Water-closets, 7-9 
Whooping-cough, 94 
Windows, 48 

Woodbridge, Prof. S. H., 16 
Work, assignment of, 130 



OtL 12 1903 



